Healthcare Provider Details

I. General information

NPI: 1912639550
Provider Name (Legal Business Name): AMY AUGENSTEIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2022
Last Update Date: 09/12/2023
Certification Date: 09/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 MOURNING DOVE DR
SAUNDERSTOWN RI
02874-2209
US

IV. Provider business mailing address

97 WOODMONT DR
CRANSTON RI
02920-3325
US

V. Phone/Fax

Practice location:
  • Phone: 401-487-8994
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number03759
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number63755
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: