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General NPI Number Information
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NPI Number | 1356205009
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Entity Type | Individual
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Provider Name | AUTUMN ANGEL MCDERMOTT
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Gender | Female
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Dates
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Enumeration Date | 12/16/2025
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Last Update Date | 12/16/2025
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Provider Practice Location Address
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Address Line | 6200 N LA CHOLLA BLVD
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City | TUCSON
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State | AZ
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Zip | 85741-3529
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Country | US
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Telephone | 661-618-5465
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Fax |
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Provider Business Mailing Address
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Address Line | 37948 58TH ST E
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City | PALMDALE
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State | CA
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Zip | 93552-3911
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Country | US
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Telephone | 661-618-5465
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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 | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 304847
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License Number State | AZ
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