Provider Demographics
NPI:1578512745
Name:OSBORNE, MARY ANN (NP DNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ANN
Last Name:OSBORNE
Suffix:
Gender:F
Credentials:NP DNP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:ANN
Other - Last Name:SCHWENKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP DNP
Mailing Address - Street 1:1340 WEST MIDLAND AVENUE
Mailing Address - Street 2:
Mailing Address - City:WOODLAND PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80814
Mailing Address - Country:US
Mailing Address - Phone:719-641-2919
Mailing Address - Fax:719-687-1118
Practice Address - Street 1:1355 SOUTH 8TH STREET
Practice Address - Street 2:SUITE 202
Practice Address - City:CO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80905
Practice Address - Country:US
Practice Address - Phone:719-641-2919
Practice Address - Fax:719-687-1118
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4594363L00000X
CO80120363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner