Individual
MRS. AUTUMN ELIZABETH DITTENBER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
230 W OAK ST, FREMONT, MI 49412-1526
(231) 924-4200
Mailing address
100 MICHIGAN ST NE, MC 845, GRAND RAPIDS, MI 49503-2560
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601007826
MI
363A00000X
Physician Assistant
58848
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA58848
STATE MEDICAL LICENSE
CA
Enumeration date
08/12/2016
Last updated
05/26/2026
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