Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 30306568 | NY |
NPI | 1003249236 |
---|---|
Provider Name | Mrs. Annmarie Butler |
First Address | Holbrook, NY 11741-4118 |
Second Address | Riverhead, NY 11901-2789 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2013 |
Last Update Date | 13/11/2013 |