Healthcare Provider Details

I. General information

NPI: 1790186484
Provider Name (Legal Business Name): SETH OSGOOD FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2014
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 AIRPORT RD STE 302
WEST LEBANON NH
03784-1663
US

IV. Provider business mailing address

2520 BROADWAY ST SUITE 100
SAN ANTONIO TX
78215-1140
US

V. Phone/Fax

Practice location:
  • Phone: 888-644-7668
  • Fax: 603-856-0372
Mailing address:
  • Phone: 210-595-1019
  • Fax: 210-251-3194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP126443
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number075358-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: