Individual
KELECHI BUTLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APN-CRNA
Contact information
Practice address
19 DOREEN DR, STATEN ISLAND, NY 10303-2136
(646) 318-0428
Mailing address
19 DOREEN DR, STATEN ISLAND, NY 10303-2136
(646) 318-0428
Taxonomy
Speciality
Code
Description
License number
State
364S00000X
Clinical Nurse Specialist
26NR16538300
NJ
367500000X
Certified Registered Nurse Anesthetist
Primary
554549
NY
Other
Enumeration date
03/26/2015
Last updated
01/22/2019
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