Provider Demographics
NPI:1841504446
Name:OSBORNE, NICHOLAUS DEWITT
Entity type:Individual
Prefix:
First Name:NICHOLAUS
Middle Name:DEWITT
Last Name:OSBORNE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24110 COURTLAND OAKS ST
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-0273
Mailing Address - Country:US
Mailing Address - Phone:713-294-7999
Mailing Address - Fax:281-391-9372
Practice Address - Street 1:24110 COURTLAND OAKS ST
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-0273
Practice Address - Country:US
Practice Address - Phone:713-294-7999
Practice Address - Fax:281-391-9372
Is Sole Proprietor?:No
Enumeration Date:2010-08-06
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX013078163W00000X, 163WH1000X, 164W00000X, 374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WH1000XNursing Service ProvidersRegistered NurseHospice
No164W00000XNursing Service ProvidersLicensed Practical Nurse
No374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1659507739OtherNPI FACILITY