Provider Demographics
NPI:1396240719
Name:BUTTS, JOANN
Entity type:Individual
Prefix:
First Name:JOANN
Middle Name:
Last Name:BUTTS
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 1:21027 BATCHELDER CT
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48044-1824
Mailing Address - Country:US
Mailing Address - Phone:586-252-3024
Mailing Address - Fax:586-765-1750
Practice Address - Street 1:21027 BATCHELDER CT
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48044-1824
Practice Address - Country:US
Practice Address - Phone:586-252-3024
Practice Address - Fax:586-765-1750
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-27
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide