Provider Demographics
NPI:1740469378
Name:OSBORNE, LEEANN CHERYL (PA)
Entity type:Individual
Prefix:
First Name:LEEANN
Middle Name:CHERYL
Last Name:OSBORNE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:LEEANN
Other - Middle Name:CHERYL
Other - Last Name:STILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 4228
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-4228
Mailing Address - Country:US
Mailing Address - Phone:541-383-3005
Mailing Address - Fax:541-383-1883
Practice Address - Street 1:375 NW BEAVER ST
Practice Address - Street 2:SUITE 101
Practice Address - City:PRINEVILLE
Practice Address - State:OR
Practice Address - Zip Code:97754
Practice Address - Country:US
Practice Address - Phone:541-447-1680
Practice Address - Fax:541-447-4670
Is Sole Proprietor?:No
Enumeration Date:2007-10-31
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA01293363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR213187Medicaid
OR383860OtherMEDICARE RHC