Provider Demographics
NPI:1619787595
Name:DUBOIS, AUTUMN ROSE (CPD)
Entity type:Individual
Prefix:
First Name:AUTUMN
Middle Name:ROSE
Last Name:DUBOIS
Suffix:
Gender:F
Credentials:CPD
Other - Prefix:
Other - First Name:AUTUMN
Other - Middle Name:ROSE
Other - Last Name:GRUBB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7307 VELVET ANTLER DR
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-1913
Mailing Address - Country:US
Mailing Address - Phone:518-470-1686
Mailing Address - Fax:
Practice Address - Street 1:7307 VELVET ANTLER DR
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-1913
Practice Address - Country:US
Practice Address - Phone:518-470-1686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula