Basic Information
| Provider Information | |||||||||
| NPI: | 1477162212 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BUTLER | ||||||||
| FirstName: | CAMILLE | ||||||||
| MiddleName: | KATRINA | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MA | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 4600 3RD ST | ||||||||
| Address2: | |||||||||
| City: | MOLINE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 612656106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3097792031 | ||||||||
| FaxNumber: | 3097792013 | ||||||||
| Practice Location | |||||||||
| Address1: | 4600 3RD ST | ||||||||
| Address2: | |||||||||
| City: | MOLINE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 612656106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3097792031 | ||||||||
| FaxNumber: | 3097792013 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2020 | ||||||||
| LastUpdateDate: | 07/28/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 07/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 374700000X | Y | Nursing Service Related Providers | Technician |
No ID Information.