Healthcare Provider Details

I. General information

NPI: 1740123397
Provider Name (Legal Business Name): CAYLEE OSBORNE
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 JANET PARK DR
HIBBING MN
55746-8037
US

IV. Provider business mailing address

1717 JANET PARK DR
HIBBING MN
55746-8037
US

V. Phone/Fax

Practice location:
  • Phone: 218-969-7546
  • Fax:
Mailing address:
  • Phone: 218-969-7546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number15840
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: