Healthcare Provider Details

I. General information

NPI: 1225932262
Provider Name (Legal Business Name): CASSANDRA BUTLER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BEBE BUTLER RN

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10600 INDIAN SCHOOL RD NE
ALBUQUERQUE NM
87112-3101
US

IV. Provider business mailing address

22 WILDLIFE TRL
EDGEWOOD NM
87015-8075
US

V. Phone/Fax

Practice location:
  • Phone: 505-299-7377
  • Fax:
Mailing address:
  • Phone: 435-990-1508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number75460
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: