Healthcare Provider Details

I. General information

NPI: 1780407775
Provider Name (Legal Business Name): ALETHEA MICHELLE BUTLER NURSE PRACTIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2024
Last Update Date: 11/06/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9891 GENERAL PULLER HWY
HARTFIELD VA
23071-3122
US

IV. Provider business mailing address

70 BUTLERS AVE
LANCASTER VA
22503-2901
US

V. Phone/Fax

Practice location:
  • Phone: 804-776-9221
  • Fax:
Mailing address:
  • Phone: 804-761-1332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024190925
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: