Provider Demographics
NPI:1871050062
Name:BUTLER, NICOLE YVONNE (HAIR LOSS SPECIALIST)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:YVONNE
Last Name:BUTLER
Suffix:
Gender:F
Credentials:HAIR LOSS SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5934 GINGER DR
Mailing Address - Street 2:
Mailing Address - City:EASTVALE
Mailing Address - State:CA
Mailing Address - Zip Code:92880-0807
Mailing Address - Country:US
Mailing Address - Phone:909-917-6271
Mailing Address - Fax:
Practice Address - Street 1:5934 GINGER DR
Practice Address - Street 2:
Practice Address - City:EASTVALE
Practice Address - State:CA
Practice Address - Zip Code:92880-0807
Practice Address - Country:US
Practice Address - Phone:909-917-6271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-25
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management