Provider Demographics
NPI:1871144113
Name:BUTLER, CAROLYN (RN)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:BUTLER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 BOCES DR
Mailing Address - Street 2:
Mailing Address - City:SIDNEY CENTER
Mailing Address - State:NY
Mailing Address - Zip Code:13839-3105
Mailing Address - Country:US
Mailing Address - Phone:607-865-2535
Mailing Address - Fax:607-865-2506
Practice Address - Street 1:270 BOCES DR
Practice Address - Street 2:
Practice Address - City:SIDNEY CENTER
Practice Address - State:NY
Practice Address - Zip Code:13839-3105
Practice Address - Country:US
Practice Address - Phone:607-865-2535
Practice Address - Fax:607-865-2506
Is Sole Proprietor?:No
Enumeration Date:2019-09-27
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY759643163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool