Provider Demographics
NPI:1952668816
Name:AUGUSTINE, JULIE LEA (PA)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:LEA
Last Name:AUGUSTINE
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:866-630-9882
Mailing Address - Fax:920-683-2131
Practice Address - Street 1:1440 N 25TH ST
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-3108
Practice Address - Country:US
Practice Address - Phone:920-457-9100
Practice Address - Fax:920-457-1461
Is Sole Proprietor?:No
Enumeration Date:2012-04-17
Last Update Date:2013-12-19
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Provider Licenses
StateLicense IDTaxonomies
WI680-23363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant