MEDICARE: MONIC OSBORN LPN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	268570	AZ

General Provider Information

NPI Number	:	1275283863
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONIC OSBORN LPN

Provider Business Mailing Address
First Line	:	8400 W VIRGINIA AVE APT 1128
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85037-8369
Country	:	US
Telephone Number	:	614-962-5786
Fax Number	:

Provider Business Practice Location Address
First Line	:	8400 W VIRGINIA AVE APT 1128
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85037-8369
Country	:	US
Telephone Number	:	614-962-5786
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/25/2022
Last Update Date	:	03/25/2022

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