Basic Information
| Provider Information | |||||||||
| NPI: | 1225189756 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BUTTS | ||||||||
| FirstName: | DONNA | ||||||||
| MiddleName: | LOUISE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 22603 ANZA AVE | ||||||||
| Address2: | |||||||||
| City: | TORRANCE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 905053418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3103780366 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 11525 BROOKSHIRE AVE | ||||||||
| Address2: | ATTN MAGGIE NOLES | ||||||||
| City: | DOWNEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902414985 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5627414461 | ||||||||
| FaxNumber: | 5627414413 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/12/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | R.N. 537716 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | U1106399 | 01 | CA | DRIVERS LICENSE | OTHER | 2005010295-22 | 01 | CA | BOARD CERTIFICATION | OTHER |