Healthcare Provider Details

I. General information

NPI: 1629145966
Provider Name (Legal Business Name): PATRICIA A OSBORNE RICO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 JESSE HILL DR SE RM 402 ATLANTA STD
ATLANTA GA
30303
US

IV. Provider business mailing address

99 JESSE HILL DRIVE SE RM 402
ATLANTA GA
30303
US

V. Phone/Fax

Practice location:
  • Phone: 404-730-1418
  • Fax: 404-730-1499
Mailing address:
  • Phone: 404-730-1418
  • Fax: 404-730-1499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN060745
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: