Healthcare Provider Details

I. General information

NPI: 1518294248
Provider Name (Legal Business Name): AUTUMN J VERSACE DNP, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2009
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

689 CHESTNUT ST
SPRINGFIELD MA
01107-1620
US

IV. Provider business mailing address

689 CHESTNUT ST
SPRINGFIELD MA
01107-1620
US

V. Phone/Fax

Practice location:
  • Phone: 413-794-9802
  • Fax:
Mailing address:
  • Phone: 413-794-9802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberRN2359304
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: