Provider Demographics
NPI:1548838816
Name:BUTLER, LAURA NICOLE (MD)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:NICOLE
Last Name:BUTLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1438 S. GRAND BLVD.
Mailing Address - Street 2:
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63104
Mailing Address - Country:US
Mailing Address - Phone:314-977-4850
Mailing Address - Fax:314-977-5155
Practice Address - Street 1:1438 S. GRAND BLVD.
Practice Address - Street 2:
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63104
Practice Address - Country:US
Practice Address - Phone:314-977-4850
Practice Address - Fax:314-977-5155
Is Sole Proprietor?:No
Enumeration Date:2021-06-14
Last Update Date:2023-04-18
Deactivation Date:2023-04-03
Deactivation Code:
Reactivation Date:2023-04-18
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program