Healthcare Provider Details

I. General information

NPI: 1194453878
Provider Name (Legal Business Name): NIKIA PATRICE AUSTIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2022
Last Update Date: 08/14/2022
Certification Date: 08/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1511 N ROBINSON ST
PHILADELPHIA PA
19151-4245
US

IV. Provider business mailing address

1511 N ROBINSON ST
PHILADELPHIA PA
19151-4245
US

V. Phone/Fax

Practice location:
  • Phone: 215-594-5133
  • Fax:
Mailing address:
  • Phone: 215-594-5133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: