Provider Demographics
NPI:1710481320
Name:ABAZIE, AUGUSTA
Entity Type:Individual
Prefix:
First Name:AUGUSTA
Middle Name:
Last Name:ABAZIE
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 1:642 ELDERWOOD LOOP
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75181-1162
Mailing Address - Country:US
Mailing Address - Phone:972-598-7810
Mailing Address - Fax:
Practice Address - Street 1:642 ELDERWOOD LOOP
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75181-1162
Practice Address - Country:US
Practice Address - Phone:972-598-7810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-19
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX323210164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse