MEDICARE: DR. MARYANN KATHARYN OSUCHOWSKI PHD, FNP-BC

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	CNP00739	NM
2	363LF0000X	Family Nurse Practitioner	R35143	NM

General Provider Information

NPI Number	:	1841327772
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARYANN KATHARYN OSUCHOWSKI PHD, FNP-BC

Provider Business Mailing Address
First Line	:	PO BOX 832
Second Line	:
City	:	LAS VEGAS
State	:	NM
Zip	:	87701-0832
Country	:	US
Telephone Number	:	505-398-1160
Fax Number	:

Provider Business Practice Location Address
First Line	:	1301 8TH ST
Second Line	:
City	:	LAS VEGAS
State	:	NM
Zip	:	87701-4221
Country	:	US
Telephone Number	:	505-398-1160
Fax Number	:

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

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	08/02/2024

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