Healthcare Provider Details

I. General information

NPI: 1932374725
Provider Name (Legal Business Name): AUTUMN LEIGH COLE MSN, R.N. FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AUTUMN LEIGH LEITZKE R.N.

II. Dates (important events)

Enumeration Date: 04/23/2008
Last Update Date: 12/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 MANKATO AVE
WINONA MN
55987-4868
US

IV. Provider business mailing address

855 MANKATO AVE
WINONA MN
55987-4868
US

V. Phone/Fax

Practice location:
  • Phone: 507-454-3650
  • Fax:
Mailing address:
  • Phone: 715-207-7164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number150839-30
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4837-33
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number223185-1
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: