Basic Information
| Provider Information | |||||||||
| NPI: | 1740673532 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BUTLER | ||||||||
| FirstName: | QIANA | ||||||||
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| Credential: | LPN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 979 MYRTLE AVE | ||||||||
| Address2: | APT 3E | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112066644 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3476385709 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2052 TILLOTSON AVE | ||||||||
| Address2: | PIONEER HOME CARE | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10475 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186712100 | ||||||||
| FaxNumber: | 7186711269 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/18/2015 | ||||||||
| LastUpdateDate: | 03/18/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | 305044 | NY | Y | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.