Healthcare Provider Details

I. General information

NPI: 1831055664
Provider Name (Legal Business Name): ANNIE JUNE OSBOURN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2025
Last Update Date: 12/23/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13001 E 17TH PL RM E7019
AURORA CO
80045-2570
US

IV. Provider business mailing address

13001 E. 17TH PLACE, ROOM E7019 MAIL STOP F543
AURORA CO
80045
US

V. Phone/Fax

Practice location:
  • Phone: 303-724-7963
  • Fax:
Mailing address:
  • Phone: 970-819-5457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: