Provider Demographics
NPI:1184329757
Name:AUGENSTENE, KERI
Entity type:Individual
Prefix:
First Name:KERI
Middle Name:
Last Name:AUGENSTENE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1153 CENTRE STREET
Mailing Address - Street 2:SUITE 4H
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02130
Mailing Address - Country:US
Mailing Address - Phone:617-983-7580
Mailing Address - Fax:617-983-7582
Practice Address - Street 1:1153 CENTRE ST STE 4H
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02130-3446
Practice Address - Country:US
Practice Address - Phone:617-983-7580
Practice Address - Fax:617-983-7582
Is Sole Proprietor?:No
Enumeration Date:2023-04-03
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant