Provider Demographics
NPI:1225539414
Name:BUTLER, JERRY PAUL (RN)
Entity type:Individual
Prefix:
First Name:JERRY
Middle Name:PAUL
Last Name:BUTLER
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:257 LINDEN AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-4234
Mailing Address - Country:US
Mailing Address - Phone:740-670-4229
Mailing Address - Fax:
Practice Address - Street 1:257 LINDEN AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-4234
Practice Address - Country:US
Practice Address - Phone:740-670-4229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-23
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH297719163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse