MEDICARE: KELI BUTLER LPN

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	164W00000X	Licensed Practical Nurse	312534	NY

General Provider Information

NPI Number	:	1578906046
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELI BUTLER LPN

Provider Business Mailing Address
First Line	:	111 CASPAR ST
Second Line	:	APT 6
City	:	ROCHESTER
State	:	NY
Zip	:	14605-1513
Country	:	US
Telephone Number	:	585-935-1644
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 CASPAR ST
Second Line	:	APT 6
City	:	ROCHESTER
State	:	NY
Zip	:	14605-1513
Country	:	US
Telephone Number	:	585-935-1644
Fax Number	:

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

Provider Enumeration Date	:	04/15/2013
Last Update Date	:	04/15/2013

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