Provider Demographics
NPI:1891715728
Name:AUGENSTEIN, ELISE JUNE (MD)
Entity Type:Individual
Prefix:DR
First Name:ELISE
Middle Name:JUNE
Last Name:AUGENSTEIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 SE BISHOP BLVD
Mailing Address - Street 2:SUITE 401
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163-5517
Mailing Address - Country:US
Mailing Address - Phone:509-339-2394
Mailing Address - Fax:
Practice Address - Street 1:804 S WASHINGTON ST
Practice Address - Street 2:SUITE A
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843-3182
Practice Address - Country:US
Practice Address - Phone:208-883-6476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA419482084P0800X
IDM-85752084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA23913OtherGROUP HEALTH COOPERATIVE
WA8367062Medicaid
WA911031583 1583AUOtherASURIS NORTHWEST HEALTH
WAAB38001Medicare ID - Type Unspecified
WA8367062Medicaid