MEDICARE: AUTUMN RODELL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	342000000X	Transportation Network Company		WI

General Provider Information

NPI Number	:	1205784873
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUTUMN RODELL

Provider Business Mailing Address
First Line	:	1421 N BIRD ST
Second Line	:
City	:	SUN PRAIRIE
State	:	WI
Zip	:	53590-1181
Country	:	US
Telephone Number	:	608-446-3463
Fax Number	:

Provider Business Practice Location Address
First Line	:	1421 N BIRD ST
Second Line	:
City	:	SUN PRAIRIE
State	:	WI
Zip	:	53590-1181
Country	:	US
Telephone Number	:	608-446-3463
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/19/2026
Last Update Date	:	03/19/2026

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Directions to “ AUTUMN RODELL ” Practice Location

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