Provider Demographics
NPI:1619190469
Name:OSBORN, LAURA LILIANA
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:LILIANA
Last Name:OSBORN
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 1:562 S BLUFF ST
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:IN
Mailing Address - Zip Code:47960-2466
Mailing Address - Country:US
Mailing Address - Phone:574-583-8492
Mailing Address - Fax:574-583-8492
Practice Address - Street 1:562 S BLUFF ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:IN
Practice Address - Zip Code:47960-2466
Practice Address - Country:US
Practice Address - Phone:574-583-8492
Practice Address - Fax:574-583-8492
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter