Provider Demographics
NPI:1669860623
Name:BUTLER, PATRICIA DIANE (RD, LDN, CDCES)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:DIANE
Last Name:BUTLER
Suffix:
Gender:F
Credentials:RD, LDN, CDCES
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:DIANE
Other - Last Name:BUTLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD, LDN, CDCES
Mailing Address - Street 1:1709 SONESTA CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-8562
Mailing Address - Country:US
Mailing Address - Phone:919-622-2175
Mailing Address - Fax:
Practice Address - Street 1:1709 SONESTA CT
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27613-8562
Practice Address - Country:US
Practice Address - Phone:919-622-2174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-29
Last Update Date:2025-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL004281133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered