Doctor Name: | MRS. AUTUMN M HULTZ |
NPI Number: | 1639488067 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PA-C |
License Number: | MA054618 |
Business Practice Address: | 405 Liberty Street Perryopolis, PA - 154730646 |
Business Phone Number: | 7247360443 |
Business Fax Number: | 7247360454 |
Mailing Address: | Po Box 646, 405 Liberty Street PERRYOPOLIS |
State: | PA |
Postal Code: | 154730646 |
Phone Number: | 7247360443 |
Fax Number: | 7247360454 |
NPI Enumeration Date: | 10/04/2010 |
NPI Last Update Date: | 09/22/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | MA054618 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |