Provider Demographics
NPI:1194004127
Name:OSBORNE, LISA ANN (LPN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:OSBORNE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8121 CLAUS RD
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:OH
Mailing Address - Zip Code:44001-9600
Mailing Address - Country:US
Mailing Address - Phone:440-986-0169
Mailing Address - Fax:
Practice Address - Street 1:8121 CLAUS RD
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:OH
Practice Address - Zip Code:44001-9600
Practice Address - Country:US
Practice Address - Phone:440-986-0169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-08
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN096241164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse