Healthcare Provider Details

I. General information

NPI: 1336817873
Provider Name (Legal Business Name): MONTANA AUGUSTINE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2021
Last Update Date: 04/21/2025
Certification Date: 04/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 E UNIVERSITY BLVD
TUCSON AZ
85721-2218
US

IV. Provider business mailing address

29250 N HAYDEN RD
SCOTTSDALE AZ
85266-2218
US

V. Phone/Fax

Practice location:
  • Phone: 520-621-2211
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN205647
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: