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General NPI Number Information
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NPI Number | 1831954932
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Entity Type | Individual
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Provider Name | AUTUMN EAU CLAIRE NEWBERRY
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Gender | Female
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Dates
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Enumeration Date | 02/19/2024
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Last Update Date | 05/30/2025
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Provider Practice Location Address
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Address Line | 103 GOSSMAN RD
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City | SOUTHERN PINES
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State | NC
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Zip | 28387-2225
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Country | US
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Telephone | 800-226-8874
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Fax |
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Provider Business Mailing Address
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Address Line | 3800 S OCEAN DR STE 209
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City | HOLLYWOOD
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State | FL
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Zip | 33019-2915
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Country | US
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Telephone | 800-226-8874
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 5022152
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License Number State | NC
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