Provider Demographics
NPI:1073720298
Name:OSBURN, ANITA MARIE
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:MARIE
Last Name:OSBURN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANITA
Other - Middle Name:
Other - Last Name:OSBURN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD, CDE
Mailing Address - Street 1:288 CRIMSON LN
Mailing Address - Street 2:
Mailing Address - City:MAX MEADOWS
Mailing Address - State:VA
Mailing Address - Zip Code:24360-3845
Mailing Address - Country:US
Mailing Address - Phone:276-637-6677
Mailing Address - Fax:540-994-8243
Practice Address - Street 1:2400 LEE HWY N
Practice Address - Street 2:
Practice Address - City:PULASKI
Practice Address - State:VA
Practice Address - Zip Code:24301-2326
Practice Address - Country:US
Practice Address - Phone:540-994-8561
Practice Address - Fax:540-994-8243
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered