MEDICARE: AUGUSTIN HARELIMANA NP

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	363LF0000X	Family Nurse Practitioner	AP10793	AZ
2	251S00000X	Community/Behavioral Health Agency	AP10793	AZ
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP10793	AZ

General Provider Information

NPI Number	:	1396253761
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUGUSTIN HARELIMANA NP

Provider Business Mailing Address
First Line	:	5205 W PEDRO LN
Second Line	:
City	:	LAVEEN
State	:	AZ
Zip	:	85339-7193
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5205 W PEDRO LN
Second Line	:
City	:	LAVEEN
State	:	AZ
Zip	:	85339-7193
Country	:	US
Telephone Number	:	602-550-1490
Fax Number	:

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

Provider Enumeration Date	:	01/18/2018
Last Update Date	:	05/01/2026

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