Provider Demographics
NPI:1518403658
Name:OSMAN, LIBAN (NP MSN)
Entity Type:Individual
Prefix:
First Name:LIBAN
Middle Name:
Last Name:OSMAN
Suffix:
Gender:M
Credentials:NP MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9365
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-0139
Mailing Address - Country:US
Mailing Address - Phone:480-687-7190
Mailing Address - Fax:
Practice Address - Street 1:4139 W BELL RD STE 8AND9
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85053-2753
Practice Address - Country:US
Practice Address - Phone:480-687-7190
Practice Address - Fax:480-687-7292
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-12
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP9647363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner