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General NPI Number Information
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NPI Number | 1902193014
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Entity Type | Individual
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Provider Name | JANICE BETH BUTLER PA-C
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Gender | Female
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Dates
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Enumeration Date | 07/09/2011
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Last Update Date | 07/09/2011
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Provider Practice Location Address
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Address Line | HC 1 BOX 61 3206 S 75 E
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City | DATELAND
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State | AZ
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Zip | 85333-9708
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Country | US
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Telephone | 928-388-7638
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Fax |
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Provider Business Mailing Address
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Address Line | HC 1 BOX 61 3206 S 75 E
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City | DATELAND
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State | AZ
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Zip | 85333-9708
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Country | US
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Telephone | 928-388-7638
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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 | 3170
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License Number State | AZ
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