Provider Demographics
NPI:1811760960
Name:BUTLER, SUZANNE (PMHNP)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:BUTLER
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7981 SUMTER RIDGE LN APT 3306
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27617-6727
Mailing Address - Country:US
Mailing Address - Phone:919-805-8596
Mailing Address - Fax:
Practice Address - Street 1:7981 SUMTER RIDGE LN APT 3306
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27617-6727
Practice Address - Country:US
Practice Address - Phone:919-805-8596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-31
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5019097363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health