Healthcare Provider Details

I. General information

NPI: 1013149467
Provider Name (Legal Business Name): AUTUMN HOVERTER MS RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AUTUMN ANTHONY

II. Dates (important events)

Enumeration Date: 08/19/2009
Last Update Date: 08/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9219 LINDEN AVE N
SEATTLE WA
98103-3226
US

IV. Provider business mailing address

9219 LINDEN AVE N
SEATTLE WA
98103-3226
US

V. Phone/Fax

Practice location:
  • Phone: 206-660-8069
  • Fax:
Mailing address:
  • Phone: 206-660-8069
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: