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General NPI Number Information
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NPI Number | 1437720521
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Entity Type | Individual
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Provider Name | BIANCA RAQUEL BUTO LEDWIDGE MSN, DNP
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Gender | Female
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Dates
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Enumeration Date | 07/08/2021
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Last Update Date | 08/22/2024
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Provider Practice Location Address
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Address Line | 410 SE 16TH CT APT 301
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City | FORT LAUDERDALE
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State | FL
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Zip | 33316-2553
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Country | US
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Telephone | 954-397-1186
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Fax |
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Provider Business Mailing Address
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Address Line | 7920 SEQUOIA LN
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City | PARKLAND
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State | FL
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Zip | 33067-2388
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Country | US
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Telephone |
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 11014144
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License Number State | FL
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