Active NPI
Daviana Butler
- Athletic Trainer
- Wixom, MI
National Provider Identifier
1700314747
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 210407
- Practice address
- 49881 Grand River Ave
Wixom, MI 48393-3309 - Phone
- (248) 229-4016
- NPI assigned
- Jun 2, 2017
- Last updated
- Jun 2, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 210407 | Primary |
Addresses
Primary practice location
49881 Grand River Ave
Wixom, MI 48393-3309
Mailing address
49881 Grand River Ave
Wixom, MI 48393-3309
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Verdurous Me, LLC | Athletic Trainer | Past | Accepting new patients |
| Verdurous Me, LLC | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Massage Therapist
- Wixom, MI
- NPI 1689126468
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1496361600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1496361600000",
"number": "1700314747",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "49881 GRAND RIVER AVE",
"city": "WIXOM",
"state": "MI",
"postal_code": "483933309"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "49881 GRAND RIVER AVE",
"city": "WIXOM",
"state": "MI",
"postal_code": "483933309",
"telephone_number": "248-229-4016"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BUTLER",
"first_name": "DAVIANA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-06-02",
"last_updated": "2017-06-02",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": null,
"license": "210407",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wixom, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.