Provider Demographics
NPI:1891040416
Name:GOUAYOU, AUGUSTIN
Entity Type:Individual
Prefix:
First Name:AUGUSTIN
Middle Name:
Last Name:GOUAYOU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1412 HAMPSHIRE WEST CT
Mailing Address - Street 2:APT 5
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20903-2521
Mailing Address - Country:US
Mailing Address - Phone:301-213-7520
Mailing Address - Fax:
Practice Address - Street 1:1412 HAMPSHIRE WEST CT
Practice Address - Street 2:APT 5
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20903-2521
Practice Address - Country:US
Practice Address - Phone:301-213-7520
Practice Address - Fax:301-238-4714
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-19
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1036684163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse