Provider Demographics
NPI:1114183175
Name:TRUDEAU, AUTUMN M (NP)
Entity Type:Individual
Prefix:MRS
First Name:AUTUMN
Middle Name:M
Last Name:TRUDEAU
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:184 U.S. 41 EAST
Mailing Address - Street 2:
Mailing Address - City:NEGAUNEE
Mailing Address - State:MI
Mailing Address - Zip Code:49866
Mailing Address - Country:US
Mailing Address - Phone:906-475-9977
Mailing Address - Fax:906-475-4435
Practice Address - Street 1:50 WEST M-35
Practice Address - Street 2:
Practice Address - City:GWINN
Practice Address - State:MI
Practice Address - Zip Code:49841
Practice Address - Country:US
Practice Address - Phone:906-372-4002
Practice Address - Fax:906-372-4012
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-30
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704215503363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner