Provider Demographics
NPI:1285474841
Name:BUTTERICK, CARLEENA LARINN
Entity type:Individual
Prefix:
First Name:CARLEENA
Middle Name:LARINN
Last Name:BUTTERICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1702 E HIGHWAY 44 LOT 166
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57703-2200
Mailing Address - Country:US
Mailing Address - Phone:605-872-2898
Mailing Address - Fax:
Practice Address - Street 1:1259 SETTLERS CREEK PL
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-8147
Practice Address - Country:US
Practice Address - Phone:605-391-3272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-30
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider