Provider Demographics
NPI:1063030013
Name:FIEDLER, AUTUMN M (DNP FNP-C CWOCN)
Entity Type:Individual
Prefix:
First Name:AUTUMN
Middle Name:M
Last Name:FIEDLER
Suffix:
Gender:F
Credentials:DNP FNP-C CWOCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 STAFFORD ST STE 210
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01104-3513
Mailing Address - Country:US
Mailing Address - Phone:413-748-9378
Mailing Address - Fax:
Practice Address - Street 1:300 STAFFORD ST STE 210
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-3513
Practice Address - Country:US
Practice Address - Phone:413-748-9378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-07
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN282289363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner