Provider Demographics
NPI:1275283863
Name:OSBORN, MONIC (LPN)
Entity Type:Individual
Prefix:
First Name:MONIC
Middle Name:
Last Name:OSBORN
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 1:8400 W VIRGINIA AVE APT 1128
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037-8369
Mailing Address - Country:US
Mailing Address - Phone:614-962-5786
Mailing Address - Fax:
Practice Address - Street 1:8400 W VIRGINIA AVE APT 1128
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-8369
Practice Address - Country:US
Practice Address - Phone:614-962-5786
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-25
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ268570164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse