Provider Demographics
NPI:1528161783
Name:SAUER, AUTUMN (FNP)
Entity type:Individual
Prefix:
First Name:AUTUMN
Middle Name:
Last Name:SAUER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:AUTUMN
Other - Middle Name:
Other - Last Name:DONLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5515 W 38TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-2919
Mailing Address - Country:US
Mailing Address - Phone:317-880-3838
Mailing Address - Fax:317-880-0081
Practice Address - Street 1:5515 W 38TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-2919
Practice Address - Country:US
Practice Address - Phone:317-880-3838
Practice Address - Fax:317-880-0081
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO170502363LF0000X
IN71001210A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO24287750Medicaid
COC806296Medicare PIN