Provider Demographics
NPI:1487476875
Name:BROWN, AUTUMN W (MA,PHLEBOTOMIST)
Entity type:Individual
Prefix:
First Name:AUTUMN
Middle Name:W
Last Name:BROWN
Suffix:
Gender:F
Credentials:MA,PHLEBOTOMIST
Other - Prefix:
Other - First Name:AUTUMN
Other - Middle Name:WENDY
Other - Last Name:MCCLOUD-BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA,PHLEBOTOMIST
Mailing Address - Street 1:6969 N PORT WASHINGTON RD
Mailing Address - Street 2:SUITE B150
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53217
Mailing Address - Country:US
Mailing Address - Phone:262-336-1371
Mailing Address - Fax:
Practice Address - Street 1:8917 W LAWRENCE AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53225
Practice Address - Country:US
Practice Address - Phone:262-336-1371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIH7Z3Y8Z4246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy