MEDICARE: MONIQUE BUTLER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1457165557
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONIQUE BUTLER

Provider Business Mailing Address
First Line	:	4203 58TH AVE APT T1
Second Line	:
City	:	BLADENSBURG
State	:	MD
Zip	:	20710-0019
Country	:	US
Telephone Number	:	769-216-4709
Fax Number	:

Provider Business Practice Location Address
First Line	:	808 BLADENSBURG RD NE APT 217
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20002-7444
Country	:	US
Telephone Number	:	202-386-4423
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2025
Last Update Date	:	02/07/2025

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Directions to “ MONIQUE BUTLER ” Practice Location

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