Healthcare Provider Details

I. General information

NPI: 1417443169
Provider Name (Legal Business Name): BRENDAN BUTLER NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2018
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25228 LANKFORD HWY
ONLEY VA
23418
US

IV. Provider business mailing address

20280 MARKET ST
ONANCOCK VA
23417-1331
US

V. Phone/Fax

Practice location:
  • Phone: 757-787-1465
  • Fax:
Mailing address:
  • Phone: 757-414-0400
  • Fax: 757-414-0400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberR232767
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR232767
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR232767
License Number StateMD
# 4
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number0024178038
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: