Basic Information
| Provider Information | |||||||||
| NPI: | 1033432752 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OSBORN | ||||||||
| FirstName: | COLLEEN | ||||||||
| MiddleName: | P | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | LPN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 105 CLEARFIELD DR | ||||||||
| Address2: | |||||||||
| City: | WILLIAMSVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142212405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166888846 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2560 WALDEN AVE STE 101 | ||||||||
| Address2: | |||||||||
| City: | CHEEKTOWAGA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142254757 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166835202 | ||||||||
| FaxNumber: | 7165835742 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2010 | ||||||||
| LastUpdateDate: | 03/09/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | 254051-1 | NY | Y | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.