Provider Demographics
NPI:1194002055
Name:OSENBRUCK, STACEY
Entity Type:Individual
Prefix:MISS
First Name:STACEY
Middle Name:
Last Name:OSENBRUCK
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:STACEY
Other - Middle Name:
Other - Last Name:RAIJSKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:301 LAKE ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:PA
Mailing Address - Zip Code:18612-7752
Mailing Address - Country:US
Mailing Address - Phone:973-616-2419
Mailing Address - Fax:
Practice Address - Street 1:901 EAST 16TH STREET
Practice Address - Street 2:
Practice Address - City:BERWICK
Practice Address - State:PA
Practice Address - Zip Code:18603
Practice Address - Country:US
Practice Address - Phone:570-759-5643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-07
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program