Healthcare Provider Details

I. General information

NPI: 1053525717
Provider Name (Legal Business Name): REBECCA JEANNE BUTLER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 PAIGE HILL RD
BRIMFIELD MA
01010-9777
US

IV. Provider business mailing address

145 PAIGE HILL RD
BRIMFIELD MA
01010-9777
US

V. Phone/Fax

Practice location:
  • Phone: 413-245-9485
  • Fax:
Mailing address:
  • Phone: 413-245-9485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number253575
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: