Healthcare Provider Details

I. General information

NPI: 1962363093
Provider Name (Legal Business Name): MS. AUTUMN LODGE-DUVERNEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2025
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N DUPONT HWY # 307
DOVER DE
19901-2202
US

IV. Provider business mailing address

1200 N DUPONT HWY # 307
DOVER DE
19901-2202
US

V. Phone/Fax

Practice location:
  • Phone: 302-736-2365
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number390200000X
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: