Basic Information
| Provider Information | |||||||||
| NPI: | 1942392923 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AUSTIN | ||||||||
| FirstName: | MARIE | ||||||||
| MiddleName: | RENE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | CRNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | WALTER REED NATIONAL MILITARY CTR | ||||||||
| Address2: | 8901 WISCONSIN AVENUE | ||||||||
| City: | BETHESDA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208897938 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3012950196 | ||||||||
| FaxNumber: | 3013194712 | ||||||||
| Practice Location | |||||||||
| Address1: | 8901 WISCONSIN AVENUE | ||||||||
| Address2: | WALTER REED NATIONAL MILITARY MEDICAL CENTER | ||||||||
| City: | BETHESDA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208892451 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3013675914 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2006 | ||||||||
| LastUpdateDate: | 04/23/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | R059654 | MD | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.