Healthcare Provider Details

I. General information

NPI: 1548843352
Provider Name (Legal Business Name): VIRGINIA LEIGH BUTLER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2021
Last Update Date: 10/19/2022
Certification Date: 10/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4041 SOUTH MCCLINTOCK DRIVE SUITE 302
TEMPE AZ
85282
US

IV. Provider business mailing address

4041 S MCCLINTOCK DR STE 302
TEMPE AZ
85282-5879
US

V. Phone/Fax

Practice location:
  • Phone: 480-339-1780
  • Fax:
Mailing address:
  • Phone: 520-233-7111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number256279
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: