Provider Demographics
NPI:1598104408
Name:BUTLER, MARQUETTA DIONNE (RN, CRNA (PENDING))
Entity type:Individual
Prefix:MRS
First Name:MARQUETTA
Middle Name:DIONNE
Last Name:BUTLER
Suffix:
Gender:F
Credentials:RN, CRNA (PENDING)
Other - Prefix:MS
Other - First Name:MARQUETTA
Other - Middle Name:DIONNE
Other - Last Name:HERNANDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:28110 DOVEWOOD CT
Mailing Address - Street 2:APT. 303
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34135-2885
Mailing Address - Country:US
Mailing Address - Phone:678-908-4946
Mailing Address - Fax:
Practice Address - Street 1:1635 OLD 41 HWY NW
Practice Address - Street 2:SUITE 112-328
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-4480
Practice Address - Country:US
Practice Address - Phone:770-732-3664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-25
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN176690367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered