Healthcare Provider Details

I. General information

NPI: 1073720298
Provider Name (Legal Business Name): ANITA MARIE OSBURN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANITA OSBURN RD, CDE

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 LEE HWY N
PULASKI VA
24301-2326
US

IV. Provider business mailing address

288 CRIMSON LN
MAX MEADOWS VA
24360-3845
US

V. Phone/Fax

Practice location:
  • Phone: 540-994-8561
  • Fax: 540-994-8243
Mailing address:
  • Phone: 276-637-6677
  • Fax: 540-994-8243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: