Healthcare Provider Details

I. General information

NPI: 1578644050
Provider Name (Legal Business Name): PENNY R OSBORN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PENNY R OSBORN-SLINGS PA-

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 10/31/2024
Certification Date: 10/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 SHAKESPEARE AVE
STRATFORD IA
50249-7774
US

IV. Provider business mailing address

913 BYRON ST
STRATFORD IA
50249-7759
US

V. Phone/Fax

Practice location:
  • Phone: 515-838-2100
  • Fax: 515-838-2193
Mailing address:
  • Phone: 515-360-1006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1059
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: