Healthcare Provider Details

I. General information

NPI: 1043646904
Provider Name (Legal Business Name): PATRICIA GOAD OSBORNE FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2013
Last Update Date: 09/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 PINE ST
HILLSVILLE VA
24343-1405
US

IV. Provider business mailing address

702 PINE ST
HILLSVILLE VA
24343-1405
US

V. Phone/Fax

Practice location:
  • Phone: 276-728-4311
  • Fax: 276-728-0901
Mailing address:
  • Phone: 276-728-4311
  • Fax: 276-728-0901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024170673
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: