Provider Demographics
NPI:1447659834
Name:BUTLER CHING, MARY SUSAN (PNP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:SUSAN
Last Name:BUTLER CHING
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:SUSIE
Other - Middle Name:
Other - Last Name:BUTLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3200 E CAMELBACK RD STE 250
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-2327
Mailing Address - Country:US
Mailing Address - Phone:602-933-1813
Mailing Address - Fax:
Practice Address - Street 1:1919 E THOMAS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-7710
Practice Address - Country:US
Practice Address - Phone:602-933-7246
Practice Address - Fax:602-933-4341
Is Sole Proprietor?:No
Enumeration Date:2014-08-21
Last Update Date:2018-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN168536363LP0200X
AZAP7307363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics