Healthcare Provider Details

I. General information

NPI: 1366882201
Provider Name (Legal Business Name): MELINDA FRANCES OSBURN N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELINDA FRANCES MAMEROW N.P.

II. Dates (important events)

Enumeration Date: 06/25/2013
Last Update Date: 07/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 CITIZENS PLZ SUITE 100
VICTORIA TX
77901-5754
US

IV. Provider business mailing address

696 JENTRY RD
INEZ TX
77968-3342
US

V. Phone/Fax

Practice location:
  • Phone: 361-579-1371
  • Fax: 361-579-1373
Mailing address:
  • Phone: 979-541-6457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number716851
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: