Healthcare Provider Details

I. General information

NPI: 1003739392
Provider Name (Legal Business Name): AUTUMN FAITH CAVENDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3405 MOON LN
WINNEMUCCA NV
89445-6046
US

IV. Provider business mailing address

3405 MOON LN
WINNEMUCCA NV
89445-6046
US

V. Phone/Fax

Practice location:
  • Phone: 775-777-1292
  • Fax: 775-777-1293
Mailing address:
  • Phone: 775-777-1292
  • Fax: 775-777-1293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: