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General NPI Number Information
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NPI Number | 1134546120
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Entity Type | Individual
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Provider Name | AUTUMN HIESTER M.A., SPED
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Gender | Female
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Dates
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Enumeration Date | 03/27/2014
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Last Update Date | 03/27/2014
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Provider Practice Location Address
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Address Line | 8920 HOLLY AVE NE STE 102B
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City | ALBUQUERQUE
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State | NM
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Zip | 87122-2989
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Country | US
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Telephone | 720-308-3271
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2593
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City | CORRALES
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State | NM
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Zip | 87048-2593
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 373H00000X
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Taxonomy Name | Day Training/Habilitation Specialist
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License Number |
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License Number State |
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