Provider Demographics
NPI:1114639051
Name:AGUSTIN, DANTE NAIGAN JR (REGISTERED NURSE)
Entity Type:Individual
Prefix:MR
First Name:DANTE
Middle Name:NAIGAN
Last Name:AGUSTIN
Suffix:JR
Gender:M
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13416 BEAR CREEK LN
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77384-2034
Mailing Address - Country:US
Mailing Address - Phone:217-981-2928
Mailing Address - Fax:
Practice Address - Street 1:CORNER OF ROUTES N12 AND N7
Practice Address - Street 2:
Practice Address - City:FORT DEFIANCE
Practice Address - State:AZ
Practice Address - Zip Code:86504-8650
Practice Address - Country:US
Practice Address - Phone:928-729-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-22
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1088630163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1088630OtherEMERGENCY ROOM REGISTERED NURSE