Provider Demographics
NPI:1558922724
Name:AUGUSTUS, BEVERLY ELAINE
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:ELAINE
Last Name:AUGUSTUS
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 1:208 HILL ST
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48203-2551
Mailing Address - Country:US
Mailing Address - Phone:131-359-0437
Mailing Address - Fax:
Practice Address - Street 1:208 HILL ST
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:MI
Practice Address - Zip Code:48203-2551
Practice Address - Country:US
Practice Address - Phone:131-359-0437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-27
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management