Provider Demographics
NPI:1942392923
Name:AUSTIN, MARIE RENE (CRNP)
Entity Type:Individual
Prefix:MS
First Name:MARIE
Middle Name:RENE
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:CRNP
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:WALTER REED NATIONAL MILITARY CTR
Mailing Address - Street 2:8901 WISCONSIN AVENUE
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20889-7938
Mailing Address - Country:US
Mailing Address - Phone:301-295-0196
Mailing Address - Fax:301-319-4712
Practice Address - Street 1:8901 WISCONSIN AVENUE
Practice Address - Street 2:WALTER REED NATIONAL MILITARY MEDICAL CENTER
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20889-2451
Practice Address - Country:US
Practice Address - Phone:301-367-5914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR059654363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCVAD0006Medicare UPIN