Provider Demographics
NPI:1194191163
Name:OSBORN, AIMEE DIANE
Entity Type:Individual
Prefix:
First Name:AIMEE
Middle Name:DIANE
Last Name:OSBORN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:941 S SERRANO DR
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-8605
Mailing Address - Country:US
Mailing Address - Phone:907-306-9873
Mailing Address - Fax:
Practice Address - Street 1:941 S SERRANO DR
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-8605
Practice Address - Country:US
Practice Address - Phone:907-306-9873
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-13
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK36758163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse