MEDICARE: MS. NICOLE ANN AUGUSTINE MA, RD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian		AZ

General Provider Information

NPI Number	:	1225274301
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NICOLE ANN AUGUSTINE MA, RD

Provider Business Mailing Address
First Line	:	27842 N 30TH LN
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85083-5841
Country	:	US
Telephone Number	:	402-770-1580
Fax Number	:

Provider Business Practice Location Address
First Line	:	27842 N 30TH LN
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85083-5841
Country	:	US
Telephone Number	:	402-770-1580
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/19/2008
Last Update Date	:	12/31/2025

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