Individual
MR. DAVID JONATHAN BUTLAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
218 OLD MOCKSVILLE RD, STATESVILLE, NC 28625-1930
(704) 838-7570
Mailing address
200 WHITEROCK DR, MOUNT HOLLY, NC 28120-8101
(704) 326-6886
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
160852
NC
367500000X
Certified Registered Nurse Anesthetist
2690
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
AN1433
—
SC
Enumeration date
04/04/2006
Last updated
02/28/2011
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