Healthcare Provider Details

I. General information

NPI: 1528977683
Provider Name (Legal Business Name): ELOISA OSBORNE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14094 UPPER 54TH ST N
OAK PARK HEIGHTS MN
55082-1161
US

IV. Provider business mailing address

14094 UPPER 54TH ST N
OAK PARK HEIGHTS MN
55082-1161
US

V. Phone/Fax

Practice location:
  • Phone: 651-808-5328
  • Fax:
Mailing address:
  • Phone: 651-808-5328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number1108618
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: