Healthcare Provider Details

I. General information

NPI: 1356041297
Provider Name (Legal Business Name): AUTUMN MARIE HUTTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2023
Last Update Date: 03/08/2023
Certification Date: 03/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 N 6TH ST
WAUSAU WI
54403-5519
US

IV. Provider business mailing address

115 N 6TH ST
WAUSAU WI
54403-5519
US

V. Phone/Fax

Practice location:
  • Phone: 715-409-9666
  • Fax: 715-842-9245
Mailing address:
  • Phone: 715-409-9666
  • Fax: 715-842-9245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: