Provider Demographics
NPI:1487708889
Name:AUGUSTINE, SHARON K (LPN)
Entity type:Individual
Prefix:MS
First Name:SHARON
Middle Name:K
Last Name:AUGUSTINE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:SHARON
Other - Middle Name:K
Other - Last Name:KITZMILLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4308 OKEECHOBEE COURT
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-8570
Mailing Address - Country:US
Mailing Address - Phone:614-871-9135
Mailing Address - Fax:
Practice Address - Street 1:4308 OKEECHOBEE COURT
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-8570
Practice Address - Country:US
Practice Address - Phone:614-871-9135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN035275164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2100685Medicaid