Healthcare Provider Details

I. General information

NPI: 1447753223
Provider Name (Legal Business Name): CARA ELIZABETH BUTLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2018
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 TOWN CENTER PKWY
RESTON VA
20190-3219
US

IV. Provider business mailing address

11521 OLDE TIVERTON CIR APT 302
RESTON VA
20194-1928
US

V. Phone/Fax

Practice location:
  • Phone: 703-471-0919
  • Fax:
Mailing address:
  • Phone: 978-726-5195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024176186
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: