Provider Demographics
NPI:1699258657
Name:BUTLER, FAITH (LVN)
Entity type:Individual
Prefix:
First Name:FAITH
Middle Name:
Last Name:BUTLER
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:MS
Other - First Name:FAITH
Other - Middle Name:
Other - Last Name:BUTLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:9702 N SAM HOUSTON PKWY E APT 1325
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77396-4552
Mailing Address - Country:US
Mailing Address - Phone:646-833-5374
Mailing Address - Fax:
Practice Address - Street 1:9702 N SAM HOUSTON PKWY E APT 1325
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77396-4552
Practice Address - Country:US
Practice Address - Phone:646-833-5374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-14
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NP07699900164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
$$$$$$$$$OtherNA