Provider Demographics
NPI:1033432752
Name:OSBORN, COLLEEN P (LPN)
Entity Type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:P
Last Name:OSBORN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 CLEARFIELD DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-2405
Mailing Address - Country:US
Mailing Address - Phone:716-688-8846
Mailing Address - Fax:
Practice Address - Street 1:2560 WALDEN AVE STE 101
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-4757
Practice Address - Country:US
Practice Address - Phone:716-683-5202
Practice Address - Fax:716-583-5742
Is Sole Proprietor?:No
Enumeration Date:2010-03-09
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY254051-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse