Healthcare Provider Details

I. General information

NPI: 1861649246
Provider Name (Legal Business Name): PRISCILLA ANN OSBORNE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2008
Last Update Date: 08/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 W JACKSON ST
PAINESVILLE OH
44077-3210
US

IV. Provider business mailing address

7543 LAKESHORE BLVD
MADISON OH
44057-1629
US

V. Phone/Fax

Practice location:
  • Phone: 440-357-6740
  • Fax: 440-357-7906
Mailing address:
  • Phone: 440-357-6740
  • Fax: 440-357-7906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number255986
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: