Healthcare Provider Details

I. General information

NPI: 1972741569
Provider Name (Legal Business Name): LAURA T. BUTERA-BELTON CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA T BUTERA

II. Dates (important events)

Enumeration Date: 02/04/2009
Last Update Date: 03/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 W LANCASTER AVE
PAOLI PA
19301-1763
US

IV. Provider business mailing address

255 W LANCASTER AVE
PAOLI PA
19301-1763
US

V. Phone/Fax

Practice location:
  • Phone: 484-565-1513
  • Fax: 484-565-1510
Mailing address:
  • Phone: 484-565-1513
  • Fax: 484-565-1510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberSP010026
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: