Provider Demographics
NPI:1497187017
Name:AUGUSTIN, ROSE ANDREE
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:ANDREE
Last Name:AUGUSTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 PRESIDENT ST
Mailing Address - Street 2:
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-4732
Mailing Address - Country:US
Mailing Address - Phone:516-298-1572
Mailing Address - Fax:
Practice Address - Street 1:49 PRESIDENT ST
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-4732
Practice Address - Country:US
Practice Address - Phone:516-298-1572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-06
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY608010163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse