Provider Demographics
NPI:1205301595
Name:OSBORN, ANNA (RD, CNSC)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:OSBORN
Suffix:
Gender:F
Credentials:RD, CNSC
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:
Other - Last Name:OSBORN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, CNSC
Mailing Address - Street 1:1521 GULL RD
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49048-1666
Mailing Address - Country:US
Mailing Address - Phone:269-226-4943
Mailing Address - Fax:
Practice Address - Street 1:900 N 92ND ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-1202
Practice Address - Country:US
Practice Address - Phone:414-805-3310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-12
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI86082769133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered