Provider Demographics
NPI:1538981360
Name:BUTLER, MAXINE ANTONETTE (RN BSN MSHCA)
Entity type:Individual
Prefix:
First Name:MAXINE
Middle Name:ANTONETTE
Last Name:BUTLER
Suffix:
Gender:F
Credentials:RN BSN MSHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:913 EMORY CT
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-8314
Mailing Address - Country:US
Mailing Address - Phone:757-343-4435
Mailing Address - Fax:
Practice Address - Street 1:620 JOHN PAUL JONES CIR STE 275
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23708-2197
Practice Address - Country:US
Practice Address - Phone:757-953-4018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-31
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001149681163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management