Individual
REGINA ALISA BUTLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
44405 WOODWARD AVE, PONTIAC, MI 48341-5023
(248) 858-3000
Mailing address
1163 NEAFIE AVE, PONTIAC, MI 48342-1966
(248) 221-2707
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
81235
SC
163WC0400X
Case Management Registered Nurse
4704181194
MI
363LF0000X
Family Nurse Practitioner
21777
SC
363LF0000X
Family Nurse Practitioner
Primary
4704181194
MI
Other
Enumeration date
11/26/2017
Last updated
02/22/2019
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