Healthcare Provider Details

I. General information

NPI: 1013024496
Provider Name (Legal Business Name): MICHELE M OSBORNE CRNA-MNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELE M WNUK

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 06/18/2024
Certification Date: 06/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 N WESTHAVEN DR
OSHKOSH WI
54904
US

IV. Provider business mailing address

PO BOX 735044
CHICAGO IL
60673-5044
US

V. Phone/Fax

Practice location:
  • Phone: 920-303-8700
  • Fax: 920-303-5630
Mailing address:
  • Phone: 800-326-2250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number111524-030
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2070-033
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: