Provider Demographics
NPI:1467785212
Name:BUTLER, ELIZABETH ROXANNE (LMP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ROXANNE
Last Name:BUTLER
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:ROXANNE
Other - Last Name:PARISH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1316 BAYWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-9406
Mailing Address - Country:US
Mailing Address - Phone:509-205-4467
Mailing Address - Fax:509-783-6675
Practice Address - Street 1:1316 BAYWOOD AVE
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-9406
Practice Address - Country:US
Practice Address - Phone:509-205-4467
Practice Address - Fax:509-783-6675
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-11
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60091749174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist