Provider Demographics
NPI:1013016740
Name:OSGOOD, NANCY COUGHENOUR (REGISTERED DIETICIAN)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:COUGHENOUR
Last Name:OSGOOD
Suffix:
Gender:F
Credentials:REGISTERED DIETICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1417 BATTLEFIELD BLVD N
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-4516
Mailing Address - Country:US
Mailing Address - Phone:757-623-0005
Mailing Address - Fax:
Practice Address - Street 1:745 BATTLEFIELD BLVD N
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-0305
Practice Address - Country:US
Practice Address - Phone:757-623-0005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL553163133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009890T28Medicare ID - Type Unspecified