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General NPI Number Information
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NPI Number | 1407617111
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Entity Type | Individual
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Provider Name | NICOLE BUTLER
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Gender | Female
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Dates
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Enumeration Date | 01/19/2024
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Last Update Date | 01/19/2024
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Provider Practice Location Address
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Address Line | 5516 ROLLING MEADOWS WAY
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City | CAMILLUS
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State | NY
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Zip | 13031-8729
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Country | US
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Telephone | 315-882-7630
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Fax |
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Provider Business Mailing Address
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Address Line | 5516 ROLLING MEADOWS WAY
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City | CAMILLUS
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State | NY
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Zip | 13031-8729
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Country | US
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Telephone | 315-882-7630
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Fax |
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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 | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 823916
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License Number State | NY
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