Provider Demographics
NPI:1053525717
Name:BUTLER, REBECCA JEANNE (RN)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:JEANNE
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 1:145 PAIGE HILL RD
Mailing Address - Street 2:
Mailing Address - City:BRIMFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01010-9777
Mailing Address - Country:US
Mailing Address - Phone:413-245-9485
Mailing Address - Fax:
Practice Address - Street 1:145 PAIGE HILL RD
Practice Address - Street 2:
Practice Address - City:BRIMFIELD
Practice Address - State:MA
Practice Address - Zip Code:01010-9777
Practice Address - Country:US
Practice Address - Phone:413-245-9485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA253575163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0707252OtherMSS HEALTH PROVIDER NUMBE