Healthcare Provider Details

I. General information

NPI: 1457716649
Provider Name (Legal Business Name): MARK S OSHINSKY FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2015
Last Update Date: 08/24/2022
Certification Date: 08/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 JEFFERSON ST N
WADENA MN
56482-1264
US

IV. Provider business mailing address

50 S B B KING BLVD # 100
MEMPHIS TN
38103-2626
US

V. Phone/Fax

Practice location:
  • Phone: 218-631-3510
  • Fax: 218-631-7507
Mailing address:
  • Phone: 901-436-1381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2460608
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704227162
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: