Provider Demographics
NPI:1316077381
Name:BUTLER, ALLISA RENEE (MSN RN)
Entity type:Individual
Prefix:
First Name:ALLISA
Middle Name:RENEE
Last Name:BUTLER
Suffix:
Gender:F
Credentials:MSN RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8000 IH-10 WEST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230
Mailing Address - Country:US
Mailing Address - Phone:210-524-7733
Mailing Address - Fax:210-524-7734
Practice Address - Street 1:8000 IH-10 WEST
Practice Address - Street 2:SUITE 600
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230
Practice Address - Country:US
Practice Address - Phone:210-524-7733
Practice Address - Fax:210-524-7734
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX540257171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator