Provider Demographics
NPI:1861025652
Name:OSEROWSKY, NICOLIN SOFIA
Entity Type:Individual
Prefix:
First Name:NICOLIN
Middle Name:SOFIA
Last Name:OSEROWSKY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NICOLIN
Other - Middle Name:SOFIA
Other - Last Name:THALER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1500 EAST MEDICAL CENTER DRIVE
Mailing Address - Street 2:UH SOUTH F-6245
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48109
Mailing Address - Country:US
Mailing Address - Phone:734-764-6879
Mailing Address - Fax:
Practice Address - Street 1:1500 EAST MEDICAL CENTER DRIVE
Practice Address - Street 2:UH SOUTH F-6245
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109
Practice Address - Country:US
Practice Address - Phone:734-764-6879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-19
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MI4351047494390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program