Healthcare Provider Details

I. General information

NPI: 1508375114
Provider Name (Legal Business Name): JAMIE LYNN BUTLER NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2017
Last Update Date: 09/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 DUBLIN DR STE A
DOVER OH
44622-7805
US

IV. Provider business mailing address

301 ASH ST
NEWCOMERSTOWN OH
43832-9431
US

V. Phone/Fax

Practice location:
  • Phone: 330-364-8038
  • Fax:
Mailing address:
  • Phone: 740-227-0673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.332673
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.021801
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: