Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 4860874-3102 | UT |
NPI | 1023352952 |
---|---|
Provider Name | Joan Margaret Butler |
First Address | Provo, UT 84601-1677 |
Second Address | Provo, UT 84601-1677 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2012 |
Last Update Date | 15/11/2012 |