Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 04-38364 | KS |
N | 207Q00000X | Family Doctor | MD60475564 | WA |
NPI | 1003106402 |
---|---|
Provider Name | Faith Madeline Butler |
First Address | Kansas City, KS 66160-8500 |
Second Address | Kansas City, KS 66160-8500 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2011 |
Last Update Date | 17/02/2016 |