Provider Demographics
NPI:1336804269
Name:OSBORNE, JADE LORAINE MARIE
Entity Type:Individual
Prefix:
First Name:JADE
Middle Name:LORAINE MARIE
Last Name:OSBORNE
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 1:3106 E SAGINAW ST
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-4712
Mailing Address - Country:US
Mailing Address - Phone:517-337-1681
Mailing Address - Fax:517-337-1616
Practice Address - Street 1:3106 E SAGINAW ST
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-4712
Practice Address - Country:US
Practice Address - Phone:517-337-1681
Practice Address - Fax:517-337-1616
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-04
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5303036540183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician