Autumn Leigh Ann Placek, RN

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

218468 Issued in WI

Practice address

1141 Stevens St
De Pere, WI 54115-1611

Phone

(920) 671-4868

NPI assigned

Aug 20, 2015

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Autumn Fraser Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1440028800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1440028800000",
    "number": "1134595572",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1141 STEVENS ST",
            "city": "DE PERE",
            "state": "WI",
            "postal_code": "541151611",
            "telephone_number": "920-671-4868"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1141 STEVENS ST",
            "city": "DE PERE",
            "state": "WI",
            "postal_code": "541151611",
            "telephone_number": "920-671-4868"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PLACEK",
        "first_name": "AUTUMN",
        "middle_name": "LEIGH ANN",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-08-20",
        "last_updated": "2015-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "WI",
            "license": "218468",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RN LICENSE",
            "identifier": "281468",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AUTUMN",
            "last_name": "FRASER",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Nicole Jane Phillips, RN, BSN, CLC
• Sarah A Phillips, LCSW, CSAC
• Cynthia Ann Pickworth
• Connon Lee Piencikowski, D.C.
• Christy Pitsch, BCBA
• Susan Ann Platz
• David Pleshek
• Jennifer Lee Pravechek, NP-C
• Prevea Clinic, Inc.
• Stephanie Prevost, M.S.

• Registered Nurse in De Pere, WI
• Providers in De Pere, WI by specialty
• Registered Nurse in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.