Provider Demographics
NPI:1316494164
Name:NYE, AUTUMN R (APRN)
Entity type:Individual
Prefix:
First Name:AUTUMN
Middle Name:R
Last Name:NYE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:988102 NEBRASKA MEDICAL CTR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68198-8102
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4242 FARNAM ST
Practice Address - Street 2:STE 650
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68131-2813
Practice Address - Country:US
Practice Address - Phone:402-559-8600
Practice Address - Fax:402-559-5010
Is Sole Proprietor?:No
Enumeration Date:2016-09-08
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE112039363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner