MEDICARE: MS. SUSAN MARIE OSBORN FNP

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	363LF0000X	Family Nurse Practitioner	334343	NY
2	363L00000X	Nurse Practitioner	AP7335	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	000928800001	OTHER	HEALTH NOW
3	P019334343	OTHER	EXCELLUS PLANS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	177750BJ	OTHER	PREFERRED CARE

General Provider Information

NPI Number	:	1467481051
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUSAN MARIE OSBORN FNP

Provider Business Mailing Address
First Line	:	2051 W CHANDLER BLVD STE 5
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85224-6239
Country	:	US
Telephone Number	:	480-214-9000
Fax Number	:	480-214-9999

Provider Business Practice Location Address
First Line	:	17215 N 72ND DR BLDG D
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85308-8558
Country	:	US
Telephone Number	:	480-214-9000
Fax Number	:	480-214-9999

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

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	02/22/2021

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