Healthcare Provider Details

I. General information

NPI: 1144213737
Provider Name (Legal Business Name): JEAN MARIE OSGOOD ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2005
Last Update Date: 10/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 6TH ST
GRUNDY CENTER IA
50638-1529
US

IV. Provider business mailing address

18803 270TH ST
GRUNDY CENTER IA
50638-8637
US

V. Phone/Fax

Practice location:
  • Phone: 319-825-4441
  • Fax: 319-825-4440
Mailing address:
  • Phone: 641-366-2520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA-065705
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: