Provider Demographics
NPI:1609465194
Name:OSBOURNE, MAURY (RN)
Entity Type:Individual
Prefix:
First Name:MAURY
Middle Name:
Last Name:OSBOURNE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:966 GRANNY SHEPHERD RD
Mailing Address - Street 2:
Mailing Address - City:MARS HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28754-6385
Mailing Address - Country:US
Mailing Address - Phone:602-703-2638
Mailing Address - Fax:
Practice Address - Street 1:966 GRANNY SHEPHERD RD
Practice Address - Street 2:
Practice Address - City:MARS HILL
Practice Address - State:NC
Practice Address - Zip Code:28754-6385
Practice Address - Country:US
Practice Address - Phone:602-703-2638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC329703163WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0200XNursing Service ProvidersRegistered NurseOncology