Provider Demographics
NPI:1508690454
Name:EGIEBOR, AUGUSTINE I (RN)
Entity type:Individual
Prefix:
First Name:AUGUSTINE
Middle Name:I
Last Name:EGIEBOR
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6312 S FIDDLERS GREEN CIR STE 300E
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-4831
Mailing Address - Country:US
Mailing Address - Phone:720-209-0044
Mailing Address - Fax:
Practice Address - Street 1:6312 S FIDDLERS GREEN CIR STE 300E
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-4831
Practice Address - Country:US
Practice Address - Phone:720-209-0044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-31
Last Update Date:2024-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1673042163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical