Provider Demographics
NPI:1124614094
Name:BUTZ, CLARICE DAUBERT (RN)
Entity type:Individual
Prefix:
First Name:CLARICE
Middle Name:DAUBERT
Last Name:BUTZ
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 1:7534 BEAVER TREE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-3661
Mailing Address - Country:US
Mailing Address - Phone:210-952-5982
Mailing Address - Fax:
Practice Address - Street 1:7534 BEAVER TREE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-3661
Practice Address - Country:US
Practice Address - Phone:210-952-5982
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-15
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX841168163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health