Healthcare Provider Details

I. General information

NPI: 1255244935
Provider Name (Legal Business Name): ALEXANDRA BUTRYN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4433 BYRON CENTER AVE SW STE B
WYOMING MI
49519-4844
US

IV. Provider business mailing address

8230 LEESBURG PIKE STE 740
VIENNA VA
22182-2641
US

V. Phone/Fax

Practice location:
  • Phone: 703-564-1631
  • Fax:
Mailing address:
  • Phone: 703-564-1631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number4704335781
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number4704335781
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: