Provider Demographics
NPI:1265018998
Name:FERNANDEZ, AUTUMN MICHELLE (RN BSN)
Entity Type:Individual
Prefix:
First Name:AUTUMN
Middle Name:MICHELLE
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 E CAYUGA ST
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:MI
Mailing Address - Zip Code:49615-9180
Mailing Address - Country:US
Mailing Address - Phone:231-533-8610
Mailing Address - Fax:
Practice Address - Street 1:203 E CAYUGA ST
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:MI
Practice Address - Zip Code:49615-9180
Practice Address - Country:US
Practice Address - Phone:231-533-8610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704287569163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health