Healthcare Provider Details

I. General information

NPI: 1639488067
Provider Name (Legal Business Name): AUTUMN M HULTZ PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2010
Last Update Date: 10/28/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1109 2ND ST
FAYETTE CITY PA
15438-1033
US

IV. Provider business mailing address

120 5TH AVE
PITTSBURGH PA
15222-3000
US

V. Phone/Fax

Practice location:
  • Phone: 724-797-3374
  • Fax:
Mailing address:
  • Phone: 844-438-3226
  • Fax: 844-978-2756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA054618
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: