Provider Demographics
NPI:1235725888
Name:GUILBERT, AUTUMN LYNN
Entity Type:Individual
Prefix:
First Name:AUTUMN
Middle Name:LYNN
Last Name:GUILBERT
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 1:107 2ND ST SE
Mailing Address - Street 2:
Mailing Address - City:RUGBY
Mailing Address - State:ND
Mailing Address - Zip Code:58368-1801
Mailing Address - Country:US
Mailing Address - Phone:701-776-5741
Mailing Address - Fax:
Practice Address - Street 1:107 2ND ST SE
Practice Address - Street 2:
Practice Address - City:RUGBY
Practice Address - State:ND
Practice Address - Zip Code:58368-1801
Practice Address - Country:US
Practice Address - Phone:701-776-5741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-17
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDTECH865183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183700000XPharmacy Service ProvidersPharmacy TechnicianGroup - Single Specialty