Provider Demographics
NPI:1649004201
Name:WILT-BOWERS, AUTUMN EVE
Entity type:Individual
Prefix:
First Name:AUTUMN
Middle Name:EVE
Last Name:WILT-BOWERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:385 LONGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BUNKER HILL
Mailing Address - State:WV
Mailing Address - Zip Code:25413-4058
Mailing Address - Country:US
Mailing Address - Phone:304-995-4664
Mailing Address - Fax:
Practice Address - Street 1:385 LONGWOOD DR
Practice Address - Street 2:
Practice Address - City:BUNKER HILL
Practice Address - State:WV
Practice Address - Zip Code:25413-4058
Practice Address - Country:US
Practice Address - Phone:304-995-4664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant