Provider Demographics
NPI:1336471309
Name:SMITH, AUTUMN M (NP)
Entity Type:Individual
Prefix:
First Name:AUTUMN
Middle Name:M
Last Name:SMITH
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 1:15 RAILROAD AVE
Mailing Address - Street 2:
Mailing Address - City:S HAMILTON
Mailing Address - State:MA
Mailing Address - Zip Code:01982-2218
Mailing Address - Country:US
Mailing Address - Phone:978-468-7381
Mailing Address - Fax:978-468-6020
Practice Address - Street 1:15 RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:S HAMILTON
Practice Address - State:MA
Practice Address - Zip Code:01982-2218
Practice Address - Country:US
Practice Address - Phone:978-468-7381
Practice Address - Fax:978-468-6020
Is Sole Proprietor?:No
Enumeration Date:2010-02-02
Last Update Date:2017-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA280379363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner