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General NPI Number Information
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NPI Number | 1790509446
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Entity Type | Individual
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Provider Name | HAILEY LYNN BUTTH PA-C
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Gender | Female
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Dates
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Enumeration Date | 11/11/2024
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Last Update Date | 11/11/2024
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Provider Practice Location Address
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Address Line | 40 BEY LEA RD
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City | TOMS RIVER
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State | NJ
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Zip | 08753-2989
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Country | US
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Telephone | 732-341-0720
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Fax |
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Provider Business Mailing Address
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Address Line | 204 SENECA BLVD
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City | BARNEGAT
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State | NJ
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Zip | 08005-2801
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Country | US
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Telephone | 609-709-0548
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 25MP00886100
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License Number State | NJ
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