Provider Demographics
NPI:1457926859
Name:CARLTON-WISE, AUTUMN CAPRICE (MEDICAL ASSISTANT)
Entity Type:Individual
Prefix:
First Name:AUTUMN
Middle Name:CAPRICE
Last Name:CARLTON-WISE
Suffix:
Gender:F
Credentials:MEDICAL ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 TOWNHOUSE
Mailing Address - Street 2:
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-2316
Mailing Address - Country:US
Mailing Address - Phone:215-594-5396
Mailing Address - Fax:
Practice Address - Street 1:81 TOWNHOUSE
Practice Address - Street 2:
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-2316
Practice Address - Country:US
Practice Address - Phone:215-594-5396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-26
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide