Provider Demographics
NPI:1679328694
Name:VERGESON, AUTUM A
Entity type:Individual
Prefix:
First Name:AUTUM
Middle Name:A
Last Name:VERGESON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 LYONS AVE
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-1759
Mailing Address - Country:US
Mailing Address - Phone:931-255-3972
Mailing Address - Fax:
Practice Address - Street 1:1820 LYONS AVE APT 7
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-9163
Practice Address - Country:US
Practice Address - Phone:931-255-3972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health