Provider Demographics
NPI:1669740189
Name:AUGUSTINE, VIRGINIA DONG (RPN)
Entity type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:DONG
Last Name:AUGUSTINE
Suffix:
Gender:F
Credentials:RPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 NORTH MAIN ST.REET
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:11203-1040
Mailing Address - Country:US
Mailing Address - Phone:518-453-6750
Mailing Address - Fax:518-453-6785
Practice Address - Street 1:30 NORTH MAIN ST..
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:11203-1040
Practice Address - Country:US
Practice Address - Phone:518-453-6750
Practice Address - Fax:518-453-6785
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-12
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY328792-1163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool