Daviana Butler
Individual provider Active NPI Athletic Trainer · Wixom, MI
NPI 1700314747 · NPPES record last updated Jun 2, 2017
Key facts
- NPI
- 1700314747
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Athletic Trainer 2255A2300X
- License
- 210407
- Practice address
- 49881 Grand River Ave
Wixom, MI 48393-3309 - Phone
- (248) 229-4016
- NPI assigned
- Jun 2, 2017
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Verdurous Me, LLC | Past | Accepting new patients | |
| Verdurous Me, LLC | Athletic Trainer | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 210407 | Yes |
Addresses
Primary practice location
49881 Grand River Ave
Wixom, MI 48393-3309
Mailing address
49881 Grand River Ave
Wixom, MI 48393-3309
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 210407 | Other | ATHLETIC CERTIFICATION & TRAINING COMMISSION |
Other providers in Wixom, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 2, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.