MEDICARE: DIANA OSBORNE PH.D.

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	103TC0700X	Clinical Psychologist	20040538A	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	860000041	OTHER	IN	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346247830
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA OSBORNE PH.D.

Provider Business Mailing Address
First Line	:	11104 PARKVIEW CIRCLE DR
Second Line	:	STE 110
City	:	FORT WAYNE
State	:	IN
Zip	:	46845-1730
Country	:	US
Telephone Number	:	260-460-3203
Fax Number	:	260-460-3130

Provider Business Practice Location Address
First Line	:	11104 PARKVIEW CIRCLE DR
Second Line	:	STE 110
City	:	FORT WAYNE
State	:	IN
Zip	:	46845-1730
Country	:	US
Telephone Number	:	260-460-3203
Fax Number	:	260-460-3130

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

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	12/26/2012

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Directions to “ DIANA OSBORNE PH.D.” Practice Location

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