Provider Demographics
NPI:1306100862
Name:BUTLER, DENISE KIMBERLY (LPN)
Entity type:Individual
Prefix:MS
First Name:DENISE
Middle Name:KIMBERLY
Last Name:BUTLER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18145 CARDONI ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48203-2492
Mailing Address - Country:US
Mailing Address - Phone:313-909-7151
Mailing Address - Fax:
Practice Address - Street 1:32500 CONCORD DR
Practice Address - Street 2:STE.343
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-1100
Practice Address - Country:US
Practice Address - Phone:248-588-0512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-29
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703109637164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse