Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant |
NPI | 1356556385 |
---|---|
Provider Name | Rebecca Novella Butler |
First Address | La Plata, MD 20646-3549 |
Second Address | La Plata, MD 20646-3549 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2007 |
Last Update Date | 06/05/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
522051699 | FEDERAL TAX IDENTIFICATIO (01) |