Healthcare Provider Details

I. General information

NPI: 1164536801
Provider Name (Legal Business Name): PAUL J BUTLER CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 01/30/2024
Certification Date: 01/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4520 MONTGOMERY BLVD NE STE 6
ALBUQUERQUE NM
87109-1291
US

IV. Provider business mailing address

4520 MONTGOMERY BLVD NE STE 6
ALBUQUERQUE NM
87109-1291
US

V. Phone/Fax

Practice location:
  • Phone: 505-308-3145
  • Fax: 505-308-3147
Mailing address:
  • Phone: 505-308-3145
  • Fax: 505-308-3147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number26NR1159100
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number622779
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCRNA-01369
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: