Healthcare Provider Details

I. General information

NPI: 1487572822
Provider Name (Legal Business Name): LOLA F BUTLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3111 MAPLEWOOD BLVD APT 66
OMAHA NE
68134-5432
US

IV. Provider business mailing address

3111 MAPLEWOOD BLVD APT 66
OMAHA NE
68134-5432
US

V. Phone/Fax

Practice location:
  • Phone: 402-917-5658
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number19276
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: