Healthcare Provider Details

I. General information

NPI: 1215106927
Provider Name (Legal Business Name): EARTHA JACKSON OSBORNE L. V. N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: EARTHA OSBORNE JOHNSON L.V.N.

II. Dates (important events)

Enumeration Date: 02/27/2008
Last Update Date: 04/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8225 RANCH RD 620 N APT 2112
AUSTIN TX
78726-4170
US

IV. Provider business mailing address

8225 RANCH RD. FM 620 N. APT. # 2112
AUSTIN TX
78726-4170
US

V. Phone/Fax

Practice location:
  • Phone: 512-373-8229
  • Fax:
Mailing address:
  • Phone: 512-373-8229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number127237
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: