Provider Demographics
NPI:1902988223
Name:AUGUSTO, DONNA B (APRN)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:B
Last Name:AUGUSTO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 GREENCLIFF DR
Mailing Address - Street 2:
Mailing Address - City:NIANTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06357
Mailing Address - Country:US
Mailing Address - Phone:860-287-2274
Mailing Address - Fax:860-444-8895
Practice Address - Street 1:400 BAYONET ST SUITE 304
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320
Practice Address - Country:US
Practice Address - Phone:860-287-2274
Practice Address - Fax:860-444-8895
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTR38272163WP0809X
CT002142363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTDA004228723Medicaid
CT4024972Medicaid
CT4014679Medicaid
CT4014679Medicaid