Most Relevant Information
Provider Data
| NPI Number: | 1003199910 |
| Provider Name: | AUTUMN NGUYEN PAC |
| Entity Type: | Individual |
| Taxonomy Code: | 363A00000X |
| Specialty: | Physician Assistant |
| License Number: | MA055123 |
Most Important Dates
| Enumeration Date: | 09/27/2011 |
| Last Updated: | 02/17/2020 |
Provider Practice Location
38935 ANN ARBOR RD
CREDENTIALING/PAYER ENROLLMENT DEPT
LIVONIA
MI
481503397
Practice Location Phone/Fax
| Phone: | 7346320175 |
| Fax: | 7348050489 |
Provider Mailing Location
601 PARK ST
EMERGENCY DEPARTMENT
HONESDALE
PA
184311445
Provider Mailing Phone/Fax
| Phone: | 5702538140 |
| Fax: | 5702538633 |