Provider Demographics
NPI:1649737727
Name:OSBORN, MICHELLE A (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:A
Last Name:OSBORN
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:WHITE BLUFF
Mailing Address - State:TN
Mailing Address - Zip Code:37187-9020
Mailing Address - Country:US
Mailing Address - Phone:615-797-5056
Mailing Address - Fax:615-797-5051
Practice Address - Street 1:200 SCHOOL RD
Practice Address - Street 2:
Practice Address - City:WHITE BLUFF
Practice Address - State:TN
Practice Address - Zip Code:37187-9020
Practice Address - Country:US
Practice Address - Phone:615-797-5056
Practice Address - Fax:615-797-5051
Is Sole Proprietor?:No
Enumeration Date:2019-02-26
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN77152163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health