Provider Demographics
NPI:1194149864
Name:FIELDS, AUTUMN NICOLE
Entity type:Individual
Prefix:
First Name:AUTUMN
Middle Name:NICOLE
Last Name:FIELDS
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 1:397 EVERGREEN CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:DELCO
Mailing Address - State:NC
Mailing Address - Zip Code:28436-9455
Mailing Address - Country:US
Mailing Address - Phone:910-471-3659
Mailing Address - Fax:
Practice Address - Street 1:397 EVERGREEN CHURCH RD
Practice Address - Street 2:
Practice Address - City:DELCO
Practice Address - State:NC
Practice Address - Zip Code:28436-9455
Practice Address - Country:US
Practice Address - Phone:910-471-3659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-14
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide