Provider Demographics
NPI:1528494564
Name:AUGUSTSON, NELI
Entity type:Individual
Prefix:DR
First Name:NELI
Middle Name:
Last Name:AUGUSTSON
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 1:9001 HIGHVIEW LN
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-4921
Mailing Address - Country:US
Mailing Address - Phone:612-532-8925
Mailing Address - Fax:
Practice Address - Street 1:8360 CITY CENTRE DR STE 112
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-5362
Practice Address - Country:US
Practice Address - Phone:651-315-7419
Practice Address - Fax:651-382-0018
Is Sole Proprietor?:No
Enumeration Date:2013-09-23
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN64217207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine