Provider Demographics
NPI:1083723712
Name:AUGUSTINA, JUNE (RN)
Entity Type:Individual
Prefix:MS
First Name:JUNE
Middle Name:
Last Name:AUGUSTINA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:JUNE
Other - Middle Name:CAROL
Other - Last Name:MEYERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:31370 CATER RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OR
Mailing Address - Zip Code:97053-9763
Mailing Address - Country:US
Mailing Address - Phone:503-366-0332
Mailing Address - Fax:
Practice Address - Street 1:412 SW 12TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2329
Practice Address - Country:US
Practice Address - Phone:503-552-5174
Practice Address - Fax:503-552-5197
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR084054887RN171M00000X, 163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR084054887RNOtherREGISTERED NURSE LICENSE