Healthcare Provider Details

I. General information

NPI: 1427042894
Provider Name (Legal Business Name): ROANNE OSBORNE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DR. ROANNE OSBORNE

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 VETERANS DR
SAINT CLOUD MN
56303-2015
US

IV. Provider business mailing address

4801 VETERANS DR
SAINT CLOUD MN
56303-2015
US

V. Phone/Fax

Practice location:
  • Phone: 320-252-1670
  • Fax:
Mailing address:
  • Phone: 320-252-1670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number73600
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number68515-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: