Provider Demographics
NPI:1538789532
Name:BUTLER, PEGGY S
Entity type:Individual
Prefix:
First Name:PEGGY
Middle Name:S
Last Name:BUTLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 MERIDIAN AVE
Mailing Address - Street 2:
Mailing Address - City:COZAD
Mailing Address - State:NE
Mailing Address - Zip Code:69130-1159
Mailing Address - Country:US
Mailing Address - Phone:308-784-2745
Mailing Address - Fax:308-217-4504
Practice Address - Street 1:1910 MERIDIAN AVE
Practice Address - Street 2:
Practice Address - City:COZAD
Practice Address - State:NE
Practice Address - Zip Code:69130-1159
Practice Address - Country:US
Practice Address - Phone:308-784-2745
Practice Address - Fax:308-217-4504
Is Sole Proprietor?:No
Enumeration Date:2020-04-20
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE297-74163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse