Provider Demographics
NPI:1275282576
Name:MONTECINO, AUTUMN COREY
Entity Type:Individual
Prefix:
First Name:AUTUMN
Middle Name:COREY
Last Name:MONTECINO
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 1:1963 E PRATER WAY STE 101
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89434-8938
Mailing Address - Country:US
Mailing Address - Phone:775-636-6269
Mailing Address - Fax:
Practice Address - Street 1:1963 E PRATER WAY STE 101
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89434-8938
Practice Address - Country:US
Practice Address - Phone:775-636-6269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-22
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20141164137374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide