Healthcare Provider Details

I. General information

NPI: 1871144113
Provider Name (Legal Business Name): CAROLYN BUTLER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2019
Last Update Date: 09/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 BOCES DR
SIDNEY CENTER NY
13839-3105
US

IV. Provider business mailing address

270 BOCES DR
SIDNEY CENTER NY
13839-3105
US

V. Phone/Fax

Practice location:
  • Phone: 607-865-2535
  • Fax: 607-865-2506
Mailing address:
  • Phone: 607-865-2535
  • Fax: 607-865-2506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number759643
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: