MEDICARE: LESLIE DIANE BUTLER ARNP

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	363LF0000X	Family Nurse Practitioner	R0058298	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790752483
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE DIANE BUTLER ARNP

Provider Business Mailing Address
First Line	:	PO BOX 1330
Second Line	:
City	:	NORMAN
State	:	OK
Zip	:	73070
Country	:	US
Telephone Number	:	405-307-6630
Fax Number	:	405-307-6660

Provider Business Practice Location Address
First Line	:	1019 N COUNCIL AVE
Second Line	:	SUITE 1
City	:	BLANCHARD
State	:	OK
Zip	:	73010-8045
Country	:	US
Telephone Number	:	405-515-0360
Fax Number	:	405-307-5596

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

Provider Enumeration Date	:	03/02/2006
Last Update Date	:	06/23/2021

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