Provider Demographics
NPI:1861093148
Name:AUGUSTT, EDITH K (REGISTERED NURSE)
Entity type:Individual
Prefix:MS
First Name:EDITH
Middle Name:K
Last Name:AUGUSTT
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8954 RESEDA BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-6507
Mailing Address - Country:US
Mailing Address - Phone:818-477-7772
Mailing Address - Fax:
Practice Address - Street 1:8954 RESEDA BLVD STE 201
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-6507
Practice Address - Country:US
Practice Address - Phone:818-477-7772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA537016163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1619900693OtherNPPES