Provider Demographics
NPI:1861136806
Name:HUSTED, AUTUMN NICOLE (RN, BSN)
Entity type:Individual
Prefix:MRS
First Name:AUTUMN
Middle Name:NICOLE
Last Name:HUSTED
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1740 EAGLE LINKS DR
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-8158
Mailing Address - Country:US
Mailing Address - Phone:614-257-5200
Mailing Address - Fax:614-257-5922
Practice Address - Street 1:1203 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-6419
Practice Address - Country:US
Practice Address - Phone:614-257-5200
Practice Address - Fax:614-257-5922
Is Sole Proprietor?:No
Enumeration Date:2022-04-26
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH417556163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management