Provider Demographics
NPI:1346713013
Name:BUTTON, AUTUMN ANGEL (LPN)
Entity Type:Individual
Prefix:MISS
First Name:AUTUMN
Middle Name:ANGEL
Last Name:BUTTON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 COUNTY ROAD 5
Mailing Address - Street 2:
Mailing Address - City:MC DONOUGH
Mailing Address - State:NY
Mailing Address - Zip Code:13801-2181
Mailing Address - Country:US
Mailing Address - Phone:607-647-5811
Mailing Address - Fax:
Practice Address - Street 1:909 COUNTY ROAD 5
Practice Address - Street 2:
Practice Address - City:MC DONOUGH
Practice Address - State:NY
Practice Address - Zip Code:13801-2181
Practice Address - Country:US
Practice Address - Phone:607-647-5811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-05
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY306464164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse