AUTUMN LEE MITTLEIDER (NPI# 1720412968) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1720412968 |
| Entity Type | Individual |
| Full Name | AUTUMN LEE MITTLEIDER |
| Credential | PHARMD |
| Practice Address |
101 Robeson St Ste 202 Fayetteville NC 28301-5552 |
| Practice Telephone | 9106151821 |
| Practice Fax Number | 9106151057 |
| Mailing Telephone | 9106151821 |
| Mailing Fax Number | 9106151057 |
| Enumeration Date | 2013-08-23 |
| Last Update Date | 2017-02-08 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 183500000X | Pharmacist | 23731 | NC | Pharmacy Service Providers |
| Y | 1835P0018X |
Pharmacist Specialization: Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
23731 | NC | Pharmacy Service Providers |
| Street Address |
101 ROBESON ST STE 202 |
| City | FAYETTEVILLE |
| State | NC |
| Zip Code | 28301-5552 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285637397 | Leon E Dantzler | Internal Medicine | 101 Robeson St, Suite 300, Fayetteville, NC 28301-5552 | 2005-05-23 |
| 1962014803 | Paige Greene | Pharmacist | 101 Robeson St, Fayetteville, NC 28301-5552 | 2020-08-21 |
| 1013536234 | Ashley Stone | Health Educator | 101 Robeson St, Fayetteville, NC 28301-5552 | 2020-04-09 |
| 1508242280 | Kelly Fynboe | Pharmacist | 101 Robeson St, Suite 107, Fayetteville, NC 28301-5552 | 2015-08-05 |
| 1447695994 | Erik Wiglama | Internal Medicine | 101 Robeson St, Suite 300, Fayetteville, NC 28301-5552 | 2013-05-09 |
| 1588952329 | John Pasztor | Dietitian, Registered | 101 Robeson St, Suite 410, Fayetteville, NC 28301-5552 | 2011-07-14 |
| 1497045496 | Nduche Chika Onyeaso | Internal Medicine | 101 Robeson St, Suite 405, Fayetteville, NC 28301-5552 | 2011-04-11 |
| 1982900247 | Samantha Moore Paquette | Pharmacist | 101 Robeson St, Suite 107, Fayetteville, NC 28301-5552 | 2011-02-03 |
| 1386970572 | Jamie Dickerhoff | Nurse Practitioner | 101 Robeson St, Suite 410, Fayetteville, NC 28301-5552 | 2009-10-23 |
| 1700111937 | Carl Rufus Creech | Pharmacist | 101 Robeson St, Suite 107, Fayetteville, NC 28301-5552 | 2009-10-06 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134726219 | Jenna Michelle Odneal | Behavior Technician | 16915 Liverpool Pkwy. Suite B., Cornelius, NC 28301 | 2020-10-02 |
| 1790390094 | Jessica Shellman | Counselor | 408 Person St. Ste 103, Fayetteville, NC 28301 | 2020-09-14 |
| 1487205951 | Martha K Richardson | Technician | 720 Teachers Dr, Fayetteville, NC 28301 | 2019-09-25 |
| 1013568161 | Angela Rena Locklear | Counselor | 211 Lamon St, Fayeteville, NC 28301 | 2019-09-20 |
| 1619535747 | Teresa Wilson | Contractor | 1417 Canyionland Ct, Apt 209, Fayetteville, NC 28301 | 2019-06-04 |
| 1912461815 | Catherine Stevenson Nwogalanya | Community Health Worker | 1103 Hillsboro St., Fayetteville, NC 28301 | 2019-01-24 |
| 1811443187 | Michael Carroll | Counselor | 308 Peterson Place, Fayetteville, NC 28301 | 2016-08-28 |
| 1023499886 | Latifa Fedai | Nurse Practitioner | 380 Person Street, Fayettevill, NC 28301 | 2015-06-17 |
| 1265868939 | Aci Support Specialists | Community/Behavioral Health | 1725 Venna Drive, Fayetteville, NC 28301 | 2013-09-25 |
| 1871929547 | Aci Support Specialists | Day Training, Developmentally Disabled Services | 2820 Copenhagen Drive, Fayetteville, NC 28301 | 2013-09-25 |
| Find all providers in zip 28301 | ||||
| Taxonomy Code | 1835P0018X |
| Grouping | Pharmacy Service Providers |
| Classification | Pharmacist |
| Specialization | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
| Pharmacist Clinician/Clinical Pharmacy Specialist is a pharmacist with additional training and an expanded scope of practice that may include prescriptive authority, therapeutic management, and disease management. |
| Notes: Source: National Uniform Claim Committee, 2007 [1/1/2008: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518249739 | William J. Holcomb | Pharmacist | 880 Hwy 85 South, Fayetteville, GA 30215 | 2011-09-14 |
| 1669072492 | Linda Xiong | Pharmacist | 2300 Ramsey St, Fayetteville, NC 28301-3856 | 2020-10-30 |
| 1861092082 | Teresa Wells | Pharmacist | 2300 Ramsey St, Fayetteville, NC 28301-3856 | 2020-10-27 |
| 1801495874 | Chase Benson Bishop | Pharmacist | 805 Glynn St S, Fayetteville, GA 30214-2000 | 2020-10-21 |
| 1407454002 | Tiffany Udoka Uzor | Pharmacist | 134 Banks Xing, Fayetteville, GA 30214-7308 | 2020-10-15 |
| 1295341741 | Lindsey Christine Judy | Pharmacist | 72 Whitewater Ave, Fayetteville, WV 25840-9648 | 2020-09-21 |
| 1780218396 | Kevin Alexander Eason | Pharmacist | 134 Banks Xing, Fayetteville, GA 30214-7308 | 2020-02-24 |
| 1790317493 | Yancy Max Witt | Pharmacist | 134 Banks Xing, Fayetteville, GA 30214-7308 | 2020-02-10 |
| 1104471432 | Katie Dircksen | Pharmacist | 1638 Owen Dr, Fayetteville, NC 28304-3424 | 2019-08-05 |
| 1558915801 | Meghan Elizabeth Mark | Pharmacist | 2300 Ramsey St, Fayetteville, NC 28301-3856 | 2019-07-25 |
| Find all providers in FAYETTEVILLE | ||||
| City | FAYETTEVILLE |
| Zip Code | 28301 |
Please comment or provide details below to improve the information on AUTUMN LEE MITTLEIDER.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.