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General NPI Number Information
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NPI Number | 1114341260
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Entity Type | Individual
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Provider Name | REGINA BUTUK FNP
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Gender | Female
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Dates
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Enumeration Date | 02/10/2014
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Last Update Date | 03/31/2014
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Provider Practice Location Address
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Address Line | 709 BARTON ST
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City | HEARNE
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State | TX
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Zip | 77859-3009
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Country | US
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Telephone | 979-279-3451
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Fax | 979-279-5163
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Provider Business Mailing Address
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Address Line | 1500 UNIVERSITY DR E SUITE 101
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City | COLLEGE STATION
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State | TX
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Zip | 77840-2600
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Country | US
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Telephone | 979-846-1100
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Fax | 979-260-9390
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 715676
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License Number State | TX
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