Basic Information
| Provider Information | |||||||||
| NPI: | 1134101496 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BUTLER | ||||||||
| FirstName: | INEZ | ||||||||
| MiddleName: | JOAN | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 460 MAIN ST | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | MADAWASKA | ||||||||
| State: | ME | ||||||||
| PostalCode: | 047561014 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2077286359 | ||||||||
| FaxNumber: | 2077287838 | ||||||||
| Practice Location | |||||||||
| Address1: | 460 MAIN ST | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | MADAWASKA | ||||||||
| State: | ME | ||||||||
| PostalCode: | 047561014 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2077286359 | ||||||||
| FaxNumber: | 2077287838 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/14/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | R049356 | ME | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.