Healthcare Provider Details

I. General information

NPI: 1255136784
Provider Name (Legal Business Name): EMILY BUTLER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2025
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1031 LAMBERTON PL NE
ALBUQUERQUE NM
87107-1641
US

IV. Provider business mailing address

1031 LAMBERTON PL NE
ALBUQUERQUE NM
87107-1641
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-0371
  • Fax: 505-272-0376
Mailing address:
  • Phone:
  • Fax: 505-272-0376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number73678
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: