Provider Demographics
NPI:1487312146
Name:BUTTERFIELD, TRACIE CAROL
Entity type:Individual
Prefix:
First Name:TRACIE
Middle Name:CAROL
Last Name:BUTTERFIELD
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:PO BOX 1570
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:OR
Mailing Address - Zip Code:97140-1570
Mailing Address - Country:US
Mailing Address - Phone:503-925-8428
Mailing Address - Fax:503-217-7117
Practice Address - Street 1:14145 SW GALBREATH DR
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:OR
Practice Address - Zip Code:97140-9170
Practice Address - Country:US
Practice Address - Phone:503-925-8428
Practice Address - Fax:503-217-7117
Is Sole Proprietor?:No
Enumeration Date:2021-11-30
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR38D2207927247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other