Healthcare Provider Details

I. General information

NPI: 1124677232
Provider Name (Legal Business Name): SUNNI RHEA OSBORN REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2019
Last Update Date: 09/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 N. APPLE
HOUSE NM
88121-0673
US

IV. Provider business mailing address

PO BOX 673
HOUSE NM
88121-0673
US

V. Phone/Fax

Practice location:
  • Phone: 575-279-7353
  • Fax:
Mailing address:
  • Phone: 575-279-7353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number57065
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: