MEDICARE: JUDITH AUSTIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	624779	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	EPSO13210	OTHER	CA	MEDICAL

General Provider Information

NPI Number	:	1164619243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDITH AUSTIN

Provider Business Mailing Address
First Line	:	PO BOX 2719
Second Line	:
City	:	PALM DESERT
State	:	CA
Zip	:	92261-2719
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	74126 WINDFLOWER CT
Second Line	:
City	:	PALM DESERT
State	:	CA
Zip	:	92211-2903
Country	:	US
Telephone Number	:	760-902-1532
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2007
Last Update Date	:	11/07/2016

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