Provider Demographics
NPI:1740051424
Name:OSBORNE, GWENDOLYN SIMPSON (RN)
Entity type:Individual
Prefix:MRS
First Name:GWENDOLYN
Middle Name:SIMPSON
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 1:11163 COMMANDERS LN
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:MD
Mailing Address - Zip Code:20695-3140
Mailing Address - Country:US
Mailing Address - Phone:202-276-5296
Mailing Address - Fax:
Practice Address - Street 1:1014 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:LA PLATA
Practice Address - State:MD
Practice Address - Zip Code:20646-4228
Practice Address - Country:US
Practice Address - Phone:240-342-3240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-11
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDRN128684163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse