MEDICARE: MRS. AUTUMN NICOLE HUSTED RN, BSN

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	163WC0400X	Case Management Registered Nurse	417556	OH

General Provider Information

NPI Number	:	1861136806
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AUTUMN NICOLE HUSTED RN, BSN

Provider Business Mailing Address
First Line	:	1740 EAGLE LINKS DR
Second Line	:
City	:	MARION
State	:	OH
Zip	:	43302-8158
Country	:	US
Telephone Number	:	614-257-5200
Fax Number	:	614-257-5922

Provider Business Practice Location Address
First Line	:	1203 DELAWARE AVE
Second Line	:
City	:	MARION
State	:	OH
Zip	:	43302-6419
Country	:	US
Telephone Number	:	614-257-5200
Fax Number	:	614-257-5922

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

Provider Enumeration Date	:	04/26/2022
Last Update Date	:	03/18/2026

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