Healthcare Provider Details

I. General information

NPI: 1598637472
Provider Name (Legal Business Name): GREG OSBORNE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2025
Last Update Date: 09/22/2025
Certification Date: 09/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 W 3RD ST
DAYTON OH
45428-9000
US

IV. Provider business mailing address

252 MCDANIELS LN
SPRINGBORO OH
45066-8518
US

V. Phone/Fax

Practice location:
  • Phone: 937-236-8651
  • Fax:
Mailing address:
  • Phone: 937-414-5191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.459086
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN.459086
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: