Provider Demographics
NPI:1861649246
Name:OSBORNE, PRISCILLA ANN (RN)
Entity Type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:ANN
Last Name:OSBORNE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7543 LAKESHORE BLVD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:OH
Mailing Address - Zip Code:44057-1629
Mailing Address - Country:US
Mailing Address - Phone:440-357-6740
Mailing Address - Fax:440-357-7906
Practice Address - Street 1:7 W JACKSON ST
Practice Address - Street 2:
Practice Address - City:PAINESVILLE
Practice Address - State:OH
Practice Address - Zip Code:44077-3210
Practice Address - Country:US
Practice Address - Phone:440-357-6740
Practice Address - Fax:440-357-7906
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-27
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH255986163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care