Provider Demographics
NPI:1013298694
Name:OSBORN, RENITA C (LPN)
Entity Type:Individual
Prefix:MRS
First Name:RENITA
Middle Name:C
Last Name:OSBORN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5977 BEAR CREEK DR
Mailing Address - Street 2:APT#122
Mailing Address - City:BEDFORD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44146-2931
Mailing Address - Country:US
Mailing Address - Phone:216-240-8634
Mailing Address - Fax:
Practice Address - Street 1:5977 BEAR CREEK DR
Practice Address - Street 2:APT#122
Practice Address - City:BEDFORD HTS
Practice Address - State:OH
Practice Address - Zip Code:44146-2931
Practice Address - Country:US
Practice Address - Phone:216-240-8634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-08
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH142972164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse