Healthcare Provider Details

I. General information

NPI: 1548344948
Provider Name (Legal Business Name): LUCY BUTLER P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LUCY RICHARDSON P.A.

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W HOSPITAL RD
FRENCH CAMP CA
95231-9693
US

IV. Provider business mailing address

6600 BRUCEVILLE RD
SACRAMENTO CA
95823-4671
US

V. Phone/Fax

Practice location:
  • Phone: 209-468-6937
  • Fax: 209-468-7042
Mailing address:
  • Phone: 209-468-6937
  • Fax: 209-468-7042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA18513
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: