Provider Demographics
NPI:1346641834
Name:FOX, AUGUSTINA O
Entity type:Individual
Prefix:
First Name:AUGUSTINA
Middle Name:O
Last Name:FOX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9909 GOOD LUCK RD
Mailing Address - Street 2:APT 201
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3248
Mailing Address - Country:US
Mailing Address - Phone:240-602-5601
Mailing Address - Fax:
Practice Address - Street 1:9909 GOOD LUCK RD
Practice Address - Street 2:APT 201
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3248
Practice Address - Country:US
Practice Address - Phone:301-254-2574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-15
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLPN7641164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse