Healthcare Provider Details

I. General information

NPI: 1144075706
Provider Name (Legal Business Name): SANA WALTER JOHN AUGUSTINE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2024
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 GLENDALE AVENUE
TOLEDO OH
43623
US

IV. Provider business mailing address

PO BOX 158
ESPANOLA NM
87532-0158
US

V. Phone/Fax

Practice location:
  • Phone: 419-383-5555
  • Fax:
Mailing address:
  • Phone: 505-579-4255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number57.259607
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberRS2024-0037
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: