Healthcare Provider Details

I. General information

NPI: 1083422638
Provider Name (Legal Business Name): AUTUMN DAWN NUDD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2024
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 ELM ST
MANCHESTER NH
03101-1305
US

IV. Provider business mailing address

1260 ELM STREET
MANCHESTER NH
03101-2045
US

V. Phone/Fax

Practice location:
  • Phone: 603-314-1701
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3613
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: