Autumn Grace Cabaniss, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

12355733-3130 Issued in UT

Practice address

344 E 100 S Ste 301
Salt Lake City, UT 84111-1727

Phone

(801) 428-4257

NPI assigned

Aug 19, 2022

Last updated

Aug 19, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1660867200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660867200000",
    "number": "1790403343",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "344 E 100 S STE 301",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841111727",
            "telephone_number": "801-428-4257"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "344 E 100 S STE 301",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841111727",
            "telephone_number": "801-428-4257"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CABANISS",
        "first_name": "AUTUMN",
        "middle_name": "GRACE",
        "credential": "LPN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-08-19",
        "last_updated": "2022-08-19",
        "certification_date": "2022-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "UT",
            "license": "12355733-3130",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Licensed Practical Nurse in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Licensed Practical Nurse in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2022; 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.