Healthcare Provider Details

I. General information

NPI: 1245295286
Provider Name (Legal Business Name): TAMMY L OSBORN APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 W CHESTNUT ST
BLOOMINGTON IL
61701-2814
US

IV. Provider business mailing address

448 WYLIE DR STE L100
NORMAL IL
61761-5405
US

V. Phone/Fax

Practice location:
  • Phone: 309-557-1400
  • Fax:
Mailing address:
  • Phone: 888-924-3786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041315198
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209.030221
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: