Provider Demographics
NPI:1003152109
Name:AMASOWOMWAN, AUSTIN (DNP)
Entity type:Individual
Prefix:
First Name:AUSTIN
Middle Name:
Last Name:AMASOWOMWAN
Suffix:
Gender:M
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 231185
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-0403
Mailing Address - Country:US
Mailing Address - Phone:916-320-7699
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 231185
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-0403
Practice Address - Country:US
Practice Address - Phone:916-320-7699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-17
Last Update Date:2025-09-15
Deactivation Date:2017-11-22
Deactivation Code:
Reactivation Date:2024-11-14
Provider Licenses
StateLicense IDTaxonomies
CA95002682367500000X
CA823194163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered Nurse
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty