Healthcare Provider Details

I. General information

NPI: 1114160959
Provider Name (Legal Business Name): JOELLE BABULA BUTLER CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2009
Last Update Date: 08/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5009 HONEYGO CENTER DR SUITE 216
PERRY HALL MD
21128-9828
US

IV. Provider business mailing address

1001 CROMWELL BRIDGE RD STE 200
TOWSON MD
21286-3330
US

V. Phone/Fax

Practice location:
  • Phone: 410-256-5858
  • Fax: 410-529-2431
Mailing address:
  • Phone: 410-821-7775
  • Fax: 410-821-1320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR178191
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: