Individual
NYRVA AUGUSTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
722 NE 162ND AVE, PORTLAND, OR 97230-5760
(503) 239-8101
Mailing address
424 NE 22ND AVE, PORTLAND, OR 97232-2809
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
201508401LPN
OR
Other
Enumeration date
05/30/2019
Last updated
05/30/2019
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