Provider Demographics
NPI:1538777040
Name:AUGUSTYNIAK, NICOLE
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:AUGUSTYNIAK
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 1:325 N AVENUE B
Mailing Address - Street 2:
Mailing Address - City:CROSS PLAINS
Mailing Address - State:TX
Mailing Address - Zip Code:76443-2446
Mailing Address - Country:US
Mailing Address - Phone:505-350-7202
Mailing Address - Fax:
Practice Address - Street 1:325 N AVENUE B
Practice Address - Street 2:
Practice Address - City:CROSS PLAINS
Practice Address - State:TX
Practice Address - Zip Code:76443-2446
Practice Address - Country:US
Practice Address - Phone:505-350-7202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-21
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1634699163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse