Individual
MRS. KIM ANN AUGUSTINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
112279-030
Contact information
Practice address
4306 31ST AVE, KENOSHA, WI 53144-1913
(262) 498-1613
Mailing address
4306 31ST AVE, KENOSHA, WI 53144-1913
(262) 498-1613
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
112279-030
WI
Other
Enumeration date
02/06/2010
Last updated
02/06/2010
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