Provider Demographics
NPI:1235815523
Name:OSBORNE, DAVID CARROLL III (LPN)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:CARROLL
Last Name:OSBORNE
Suffix:III
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:122 GERONIMO DR
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:WV
Mailing Address - Zip Code:25177-3328
Mailing Address - Country:US
Mailing Address - Phone:681-427-6413
Mailing Address - Fax:
Practice Address - Street 1:4825 MACCORKLE AVE SW UNIT F
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-1365
Practice Address - Country:US
Practice Address - Phone:304-346-9667
Practice Address - Fax:304-346-9717
Is Sole Proprietor?:No
Enumeration Date:2023-06-22
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV39749164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse