Provider Demographics
NPI:1366702227
Name:BUTLER, LORRAINE LATASHA
Entity type:Individual
Prefix:
First Name:LORRAINE
Middle Name:LATASHA
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 1:4425 S CAPITOL ST SW
Mailing Address - Street 2:#102
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20032-2103
Mailing Address - Country:US
Mailing Address - Phone:240-459-4791
Mailing Address - Fax:
Practice Address - Street 1:4425 S CAPITOL ST SW
Practice Address - Street 2:#102
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-2103
Practice Address - Country:US
Practice Address - Phone:240-459-4791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-24
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide