Healthcare Provider Details

I. General information

NPI: 1558277418
Provider Name (Legal Business Name): NORMANIQUE LATRICE BUTLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 ANITA ST
BRUSLY LA
70719-2142
US

IV. Provider business mailing address

303 ANITA ST
BRUSLY LA
70719-2142
US

V. Phone/Fax

Practice location:
  • Phone: 225-888-4891
  • Fax:
Mailing address:
  • Phone: 225-888-4891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberPLC11420
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: