Provider Demographics
NPI:1649368648
Name:BUTLER, LISA B (RN, APN)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:B
Last Name:BUTLER
Suffix:
Gender:F
Credentials:RN, APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 BISHOP PL
Mailing Address - Street 2:
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-1178
Mailing Address - Country:US
Mailing Address - Phone:848-932-7402
Mailing Address - Fax:848-932-1525
Practice Address - Street 1:11 BISHOP PL
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-1178
Practice Address - Country:US
Practice Address - Phone:848-932-7402
Practice Address - Fax:848-932-1525
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2025-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00047700363L00000X
NJNJ000477363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ010006349 00OtherAMERICHOICE
NJ60030097OtherHORIZON NJ HEALTH
NJP00198287OtherRR MEDICARE
NJ0030490Medicaid
NJ2566254OtherUNIVERSITY HEALTH PLAN
NJ3K6810OtherHEALTHNET
Q01601Medicare UPIN
NJ074803 SZFMedicare PIN