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General NPI Number Information
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NPI Number | 1821051012
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Entity Type | Individual
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Provider Name | TRACEY M. BUTLER CRNA
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Gender | Female
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Dates
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Enumeration Date | 04/09/2006
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Last Update Date | 04/25/2023
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Provider Practice Location Address
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Address Line | 8401 MARKET ST
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City | YOUNGSTOWN
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State | OH
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Zip | 44512
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Country | US
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Telephone | 330-729-2929
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Fax |
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Provider Business Mailing Address
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Address Line | 4135 BOARDMAN CANFIELD RD STE 101
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City | CANFIELD
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State | OH
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Zip | 44406-9803
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Country | US
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Telephone | 330-286-5330
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Fax | 330-286-5396
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 1103844
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | RN.395377
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License Number State | OH
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