MEDICARE: NOAH GABRIEL JACOB 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	390200000X	Student in an Organized Health Care Education/Training Program	61611723	WA

General Provider Information

NPI Number	:	1609711290
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NOAH GABRIEL JACOB BUTLER

Provider Business Mailing Address
First Line	:	1323 S RAY ST
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99202-5447
Country	:	US
Telephone Number	:	509-301-3879
Fax Number	:

Provider Business Practice Location Address
First Line	:	412 E SPOKANE FALLS BLVD
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99202-2131
Country	:	US
Telephone Number	:	509-368-6700
Fax Number	:

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

Provider Enumeration Date	:	04/21/2026
Last Update Date	:	04/21/2026

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