Individual
AMANDA BUTLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
5 CLAY ST, MALONE, NY 12953-1905
(518) 483-0705
Mailing address
1233 EDGEWATER ST NW, SALEM, OR 97304-4049
(503) 378-7526
(503) 588-5815
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
030068
NY
363A00000X
Physician Assistant
15-01676
KS
363AM0700X
Medical Physician Assistant
PA174869
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15-01676
STATE LICENSE
KS
01
—
PA174869
STATE LICENSE
OR
Enumeration date
02/25/2014
Last updated
09/14/2023
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