Provider Demographics
NPI:1366225047
Name:BUTLER, MICHAEL LEON (LPN)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LEON
Last Name:BUTLER
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CUMMINGS CTR STE 166D
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-6135
Mailing Address - Country:US
Mailing Address - Phone:941-888-3228
Mailing Address - Fax:
Practice Address - Street 1:100 CUMMINGS CTR STE 166D
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-6135
Practice Address - Country:US
Practice Address - Phone:941-888-3228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN60065164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty