Provider Demographics
NPI:1770331050
Name:OSAGIE, OWEN (PMHNP (APRN))
Entity type:Individual
Prefix:
First Name:OWEN
Middle Name:
Last Name:OSAGIE
Suffix:
Gender:F
Credentials:PMHNP (APRN)
Other - Prefix:
Other - First Name:OWEN
Other - Middle Name:
Other - Last Name:ERHABOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18901 GROVE PKWY
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73012-4498
Mailing Address - Country:US
Mailing Address - Phone:580-678-7058
Mailing Address - Fax:
Practice Address - Street 1:301 NW 63RD ST STE 650
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-7915
Practice Address - Country:US
Practice Address - Phone:405-607-1717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-10
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK217120363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health