Provider Demographics
NPI:1104613348
Name:AUGUST, STARNISHA D
Entity type:Individual
Prefix:
First Name:STARNISHA
Middle Name:D
Last Name:AUGUST
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6225 S WOODLAWN AVE APT 1N
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637-3657
Mailing Address - Country:US
Mailing Address - Phone:773-620-2193
Mailing Address - Fax:
Practice Address - Street 1:6225 S WOODLAWN AVE APT 1N
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-3657
Practice Address - Country:US
Practice Address - Phone:773-620-2193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-22
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL295.000023176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife