Healthcare Provider Details

I. General information

NPI: 1831607811
Provider Name (Legal Business Name): KELECHI BUTLER CERTIFIED REGISTERED NURSE ANESTHETIST, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2018
Last Update Date: 02/22/2024
Certification Date: 02/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2416 E 15TH ST
BROOKLYN NY
11235-3502
US

IV. Provider business mailing address

2416 E 15TH ST
BROOKLYN NY
11235-3502
US

V. Phone/Fax

Practice location:
  • Phone: 305-930-0354
  • Fax:
Mailing address:
  • Phone: 718-222-5999
  • Fax: 718-387-6429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number554549
License Number StateNY

VIII. Authorized Official

Name: KELECHI BUTLER
Title or Position: NURSE ANESTHESTIST
Credential: CRNA
Phone: 305-930-0354