Healthcare Provider Details

I. General information

NPI: 1992461503
Provider Name (Legal Business Name): GRACE TAMMY OSIPOWICZ DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2021
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4530 E MUIRWOOD DR STE 111
PHOENIX AZ
85048-7693
US

IV. Provider business mailing address

4505 E CHANDLER BLVD STE 200
PHOENIX AZ
85048-7688
US

V. Phone/Fax

Practice location:
  • Phone: 480-961-2365
  • Fax: 480-961-2382
Mailing address:
  • Phone: 480-961-2365
  • Fax: 480-961-2382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number243288
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number243288
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number243288
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: