Provider Demographics
NPI:1467846758
Name:AGUSTIN, MARY ROSE (AGANCP-BC)
Entity Type:Individual
Prefix:
First Name:MARY ROSE
Middle Name:
Last Name:AGUSTIN
Suffix:
Gender:F
Credentials:AGANCP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13026 BELMONT CIR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77065-5031
Mailing Address - Country:US
Mailing Address - Phone:832-423-0895
Mailing Address - Fax:
Practice Address - Street 1:12121 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-2432
Practice Address - Country:US
Practice Address - Phone:281-679-8282
Practice Address - Fax:281-679-8290
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-24
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP127065363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care