Healthcare Provider Details

I. General information

NPI: 1225859747
Provider Name (Legal Business Name): HEAVEN LATARI BUTTS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2024
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 4TH ST SE # 3101AB
MINNEAPOLIS MN
55414-3875
US

IV. Provider business mailing address

2701 4TH ST SE # 3101AB
MINNEAPOLIS MN
55414-3875
US

V. Phone/Fax

Practice location:
  • Phone: 605-216-6058
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: