Healthcare Provider Details

I. General information

NPI: 1982147393
Provider Name (Legal Business Name): SHANNON OSBORNE MPH, CNM, WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2016
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 DOOLITTLE DR
ELLSWORTH AFB SD
57706-4821
US

IV. Provider business mailing address

2900 DOOLITTLE DR
ELLSWORTH AFB SD
57706-4821
US

V. Phone/Fax

Practice location:
  • Phone: 605-385-3494
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberCNM03795
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberCNP020326
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: