Provider Demographics
NPI:1083305718
Name:CHENKUS, AUTUMN NICOLE
Entity Type:Individual
Prefix:
First Name:AUTUMN
Middle Name:NICOLE
Last Name:CHENKUS
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 1:140 NEW ST APT 2211
Mailing Address - Street 2:
Mailing Address - City:MAMARONECK
Mailing Address - State:NY
Mailing Address - Zip Code:10543-1548
Mailing Address - Country:US
Mailing Address - Phone:803-834-2032
Mailing Address - Fax:
Practice Address - Street 1:140 NEW ST APT 2211
Practice Address - Street 2:
Practice Address - City:MAMARONECK
Practice Address - State:NY
Practice Address - Zip Code:10543-1548
Practice Address - Country:US
Practice Address - Phone:803-834-2032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY871165163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse