Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician |
NPI | 1104318575 |
---|---|
Provider Name | Kelsie Ann Butts |
First Address | Bismarck, ND 58503-5653 |
Second Address | Bismarck, ND 58503-5653 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2018 |
Last Update Date | 01/06/2018 |