Healthcare Provider Details

I. General information

NPI: 1427681428
Provider Name (Legal Business Name): MADISON OSBURN RDN, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2020
Last Update Date: 11/09/2021
Certification Date: 11/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

147 ELM CT
ANDOVER KS
67002-9028
US

IV. Provider business mailing address

147 ELM CT
ANDOVER KS
67002-9028
US

V. Phone/Fax

Practice location:
  • Phone: 316-361-6080
  • Fax: 316-844-1647
Mailing address:
  • Phone: 316-361-6080
  • Fax: 316-844-1647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2454
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: