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NPI Code Detail

MEDICARE: MS. DESERET ROBIN BUTLER LPN

MEDICARE:  MS. DESERET ROBIN 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
1164W00000XLicensed Practical Nurse1736461NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11736461OTHERNYNURSING LICENSE

General Provider Information

NPI Number : 1760713150
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. DESERET ROBIN BUTLER LPN
Provider Business Mailing Address
First Line : 2896 SAND BEACH RD
Second Line :
City : AUBURN
State : NY
Zip : 13021-5651
Country : US
Telephone Number : 315-252-3920
Fax Number :
Provider Business Practice Location Address
First Line : 2896 SAND BEACH RD
Second Line :
City : AUBURN
State : NY
Zip : 13021-5651
Country : US
Telephone Number : 315-252-3920
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/25/2010
Last Update Date : 01/27/2010

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Directions to “ MS. DESERET ROBIN BUTLER LPN” Practice Location

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