Provider Demographics
NPI:1770288862
Name:MILES, AWTUMN (FNP-BC)
Entity type:Individual
Prefix:
First Name:AWTUMN
Middle Name:
Last Name:MILES
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 S DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14204-1710
Mailing Address - Country:US
Mailing Address - Phone:716-842-3004
Mailing Address - Fax:716-842-3006
Practice Address - Street 1:414 S DIVISION ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14204-1710
Practice Address - Country:US
Practice Address - Phone:716-842-3002
Practice Address - Fax:716-842-3006
Is Sole Proprietor?:No
Enumeration Date:2023-03-30
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY351177363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner