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General NPI Number Information
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NPI Number | 1144075706
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Entity Type | Individual
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Provider Name | SANA WALTER JOHN AUGUSTINE MD
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Gender | Female
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Dates
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Enumeration Date | 04/18/2024
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Last Update Date | 12/09/2025
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Provider Practice Location Address
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Address Line | 333 GLENDALE AVENUE
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City | TOLEDO
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State | OH
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Zip | 43623
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Country | US
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Telephone | 419-383-5555
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 158
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City | ESPANOLA
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State | NM
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Zip | 87532-0158
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Country | US
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Telephone | 505-579-4255
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 57.259607
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | RS2024-0037
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License Number State | NM
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