Provider Demographics
NPI:1093868531
Name:OSBORN, SHIRLEY E (RD, LMNT)
Entity Type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:E
Last Name:OSBORN
Suffix:
Gender:F
Credentials:RD, LMNT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36631 OSBORN DR
Mailing Address - Street 2:
Mailing Address - City:MULLEN
Mailing Address - State:NE
Mailing Address - Zip Code:69152-9315
Mailing Address - Country:US
Mailing Address - Phone:308-546-2613
Mailing Address - Fax:
Practice Address - Street 1:36631 OSBORN DR
Practice Address - Street 2:HC 1 BOX 11
Practice Address - City:MULLEN
Practice Address - State:NE
Practice Address - Zip Code:69152-9315
Practice Address - Country:US
Practice Address - Phone:308-546-2613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE400133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered