Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 95001465 | CA |
NPI | 1063660546 |
---|---|
Provider Name | Mrs. Deborah Gay Butz |
First Address | Grass Valley, CA 95945-8524 |
Second Address | Teague, TX 75860-5141 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2008 |
Last Update Date | 21/06/2017 |