Provider Demographics
NPI:1841327772
Name:OSUCHOWSKI, MARYANN KATHARYN (PHD, FNP-BC)
Entity type:Individual
Prefix:DR
First Name:MARYANN
Middle Name:KATHARYN
Last Name:OSUCHOWSKI
Suffix:
Gender:F
Credentials:PHD, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 832
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NM
Mailing Address - Zip Code:87701-0832
Mailing Address - Country:US
Mailing Address - Phone:505-398-1160
Mailing Address - Fax:
Practice Address - Street 1:1301 8TH ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NM
Practice Address - Zip Code:87701-4221
Practice Address - Country:US
Practice Address - Phone:505-398-1160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP00739363LF0000X
NMR35143363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily