1326170895 NPI number — MRS. PATRICIA LOUISE OSBORNE

Table of content: MRS. PATRICIA LOUISE OSBORNE (NPI 1326170895)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326170895 NPI number — MRS. PATRICIA LOUISE OSBORNE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OSBORNE
Provider First Name:
PATRICIA
Provider Middle Name:
LOUISE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326170895
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5245 VINCENT AVE N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MINNEAPOLIS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55430-3318
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-287-9625
Provider Business Mailing Address Fax Number:
612-287-9625

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3989 CENTRAL AVE NE
Provider Second Line Business Practice Location Address:
SUITE 200F
Provider Business Practice Location Address City Name:
COLUMBIA HEIGHTS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55421-3900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-331-0617
Provider Business Practice Location Address Fax Number:
612-287-9625
Provider Enumeration Date:
03/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 156FX1800X , with the licence number:  149254 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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