Healthcare Provider Details

I. General information

NPI: 1144789777
Provider Name (Legal Business Name): AMBER SUE OSBORN PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2019
Last Update Date: 12/23/2020
Certification Date: 12/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 CENTER ST NE
SALEM OR
97301-2682
US

IV. Provider business mailing address

18060 SW SALIX RIDGE ST
BEAVERTON OR
97006-3516
US

V. Phone/Fax

Practice location:
  • Phone: 971-329-1535
  • Fax:
Mailing address:
  • Phone: 971-329-1535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number202011281NP-PP
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number201400048RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: