Healthcare Provider Details

I. General information

NPI: 1639054273
Provider Name (Legal Business Name): AURORA RAE OSTERGAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2025
Last Update Date: 08/11/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 SANDY SPRINGS ROAD
ZUNI NM
87327
US

IV. Provider business mailing address

PO BOX 615
ZUNI NM
87327-0615
US

V. Phone/Fax

Practice location:
  • Phone: 505-782-5511
  • Fax:
Mailing address:
  • Phone: 435-764-4713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number434854
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: