Provider Demographics
NPI:1720575095
Name:OSBOURN, ERIN
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:OSBOURN
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 1:909 KIPUKA DR NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-1087
Mailing Address - Country:US
Mailing Address - Phone:505-205-0238
Mailing Address - Fax:
Practice Address - Street 1:11608 BELLAMAH AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-4412
Practice Address - Country:US
Practice Address - Phone:505-205-0238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-22
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM373H00000X
1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchoolGroup - Multi-Specialty
No373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist