Provider Demographics
NPI:1770627648
Name:AUGUSTIAN, BILLINA SUSANNE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:BILLINA
Middle Name:SUSANNE
Last Name:AUGUSTIAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:923 ELIZA ST
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301-3234
Mailing Address - Country:US
Mailing Address - Phone:920-965-4800
Mailing Address - Fax:920-965-4801
Practice Address - Street 1:923 ELIZA ST
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-3234
Practice Address - Country:US
Practice Address - Phone:920-965-4800
Practice Address - Fax:920-965-4801
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1142-023363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42981300Medicaid
WI000045006-0012Medicare ID - Type Unspecified