Provider Demographics
NPI:1043816630
Name:BUTLER, MARTINA A
Entity type:Individual
Prefix:
First Name:MARTINA
Middle Name:A
Last Name:BUTLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11517 TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-2742
Mailing Address - Country:US
Mailing Address - Phone:240-298-6237
Mailing Address - Fax:
Practice Address - Street 1:1475 COLUMBIA RD NW APT 104
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-4743
Practice Address - Country:US
Practice Address - Phone:202-910-5707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant