Provider Demographics
NPI:1811415441
Name:HOWARD, AUTUMN (RD)
Entity Type:Individual
Prefix:
First Name:AUTUMN
Middle Name:
Last Name:HOWARD
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5640 HUDSON INDUSTRIAL PKWY
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-5011
Mailing Address - Country:US
Mailing Address - Phone:716-860-1313
Mailing Address - Fax:
Practice Address - Street 1:5640 HUDSON INDUSTRIAL PKWY
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:OH
Practice Address - Zip Code:44236-5011
Practice Address - Country:US
Practice Address - Phone:716-860-1313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-04
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD.08247133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered