Provider Demographics
NPI:1407491178
Name:OSONOWO, HELEN O
Entity Type:Individual
Prefix:
First Name:HELEN
Middle Name:O
Last Name:OSONOWO
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 1:10643 WELCOME BAY N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55443-3268
Mailing Address - Country:US
Mailing Address - Phone:612-207-5691
Mailing Address - Fax:763-425-4683
Practice Address - Street 1:5724 BASS LAKE RD
Practice Address - Street 2:
Practice Address - City:CRYSTAL
Practice Address - State:MN
Practice Address - Zip Code:55429-2747
Practice Address - Country:US
Practice Address - Phone:763-561-3434
Practice Address - Fax:612-314-8840
Is Sole Proprietor?:No
Enumeration Date:2019-11-16
Last Update Date:2019-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6379363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily