Healthcare Provider Details

I. General information

NPI: 1881850691
Provider Name (Legal Business Name): MS. NADINE MARY AUGUSTE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2008
Last Update Date: 03/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38 BALL TER
MAPLEWOOD NJ
07040-1804
US

IV. Provider business mailing address

38 BALL TER
MAPLEWOOD NJ
07040-1804
US

V. Phone/Fax

Practice location:
  • Phone: 917-576-0805
  • Fax:
Mailing address:
  • Phone: 917-576-0805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number430420
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number523821
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: