Provider Demographics
NPI:1912576117
Name:WESTERHOF, AUTUMN M (FNP-C)
Entity Type:Individual
Prefix:
First Name:AUTUMN
Middle Name:M
Last Name:WESTERHOF
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1587 NAUTICAL LN
Mailing Address - Street 2:
Mailing Address - City:COTTRELLVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48039-3320
Mailing Address - Country:US
Mailing Address - Phone:810-357-3168
Mailing Address - Fax:
Practice Address - Street 1:1587 NAUTICAL LN
Practice Address - Street 2:
Practice Address - City:COTTRELLVILLE
Practice Address - State:MI
Practice Address - Zip Code:48039-3320
Practice Address - Country:US
Practice Address - Phone:810-357-3168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-22
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704329563363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily