Provider Demographics
NPI:1699050526
Name:BUTLER, JUDY COLLEEN (RN)
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:COLLEEN
Last Name:BUTLER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2068 E 20TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16510-1148
Mailing Address - Country:US
Mailing Address - Phone:814-528-5896
Mailing Address - Fax:
Practice Address - Street 1:2068 E 20TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16510-1148
Practice Address - Country:US
Practice Address - Phone:814-528-5896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN336697L163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse