Provider Demographics
NPI:1093900813
Name:OSBORNE, JEAN MARIE (NP)
Entity Type:Individual
Prefix:MRS
First Name:JEAN MARIE
Middle Name:
Last Name:OSBORNE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2488 WALTERS CT
Mailing Address - Street 2:
Mailing Address - City:BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-4823
Mailing Address - Country:US
Mailing Address - Phone:516-729-3853
Mailing Address - Fax:
Practice Address - Street 1:2488 WALTERS CT
Practice Address - Street 2:
Practice Address - City:BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-4823
Practice Address - Country:US
Practice Address - Phone:516-729-3853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-14
Last Update Date:2017-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY30 304741363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health