Provider Demographics
NPI:1972286029
Name:BUTLER, ELIZABETH DAWN I
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:DAWN
Last Name:BUTLER
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 SAGASSER ST
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42501-1811
Mailing Address - Country:US
Mailing Address - Phone:859-582-4974
Mailing Address - Fax:
Practice Address - Street 1:105 SAGASSER ST
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42501-1811
Practice Address - Country:US
Practice Address - Phone:859-582-4974
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1207953175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist