Provider Demographics
NPI:1629845078
Name:SMITH, AUTUMN MARIE (RD, CDCES)
Entity Type:Individual
Prefix:
First Name:AUTUMN
Middle Name:MARIE
Last Name:SMITH
Suffix:
Gender:F
Credentials:RD, CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6006 FOREST DR
Mailing Address - Street 2:
Mailing Address - City:MONACA
Mailing Address - State:PA
Mailing Address - Zip Code:15061-2246
Mailing Address - Country:US
Mailing Address - Phone:724-513-2674
Mailing Address - Fax:
Practice Address - Street 1:6006 FOREST DR
Practice Address - Street 2:
Practice Address - City:MONACA
Practice Address - State:PA
Practice Address - Zip Code:15061-2246
Practice Address - Country:US
Practice Address - Phone:724-513-2674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-06
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered