Healthcare Provider Details

I. General information

NPI: 1093868531
Provider Name (Legal Business Name): SHIRLEY E OSBORN RD, LMNT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36631 OSBORN DR HC 1 BOX 11
MULLEN NE
69152-9315
US

IV. Provider business mailing address

36631 OSBORN DR
MULLEN NE
69152-9315
US

V. Phone/Fax

Practice location:
  • Phone: 308-546-2613
  • Fax:
Mailing address:
  • Phone: 308-546-2613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number400
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: