=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073861936
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EVA AUGUSTA PMHNP-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/27/2012
-----------------------------------------------------
Last Update Date | 02/19/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 175 DERBY ST SUITE 21
-----------------------------------------------------
City | HINGHAM
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02043-4007
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-556-5662
-----------------------------------------------------
Fax | 781-836-0676
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 175 DERBY ST SUITE #21
-----------------------------------------------------
City | HINGHAM
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02043-4007
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-556-5662
-----------------------------------------------------
Fax | 781-836-0676
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | RN2270391
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------