Provider Demographics
NPI:1861106874
Name:BUTLER, CHARLOTTE MARIE
Entity type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:MARIE
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 1:11701 INTERSTATE 30 STE 510
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72209-7075
Mailing Address - Country:US
Mailing Address - Phone:501-747-1771
Mailing Address - Fax:
Practice Address - Street 1:7407 PINEWOOD DR
Practice Address - Street 2:
Practice Address - City:MABELVALE
Practice Address - State:AR
Practice Address - Zip Code:72103-4338
Practice Address - Country:US
Practice Address - Phone:501-765-4230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-13
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion