Provider Demographics
NPI:1144789777
Name:OSBORN, AMBER SUE (PMHNP)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:SUE
Last Name:OSBORN
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18060 SW SALIX RIDGE ST
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-3516
Mailing Address - Country:US
Mailing Address - Phone:971-329-1535
Mailing Address - Fax:
Practice Address - Street 1:2600 CENTER ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-2682
Practice Address - Country:US
Practice Address - Phone:971-329-1535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-13
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR202011281NP-PP363LP0808X
OR201400048RN163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR201400048RNOtherOSBN
OR202011281NP-PPOtherOREGON STATE BOARD OF NURSING
OR201400048RNOtherOREGON STATE BOARD OF NURSING