Basic Information
| Provider Information | |||||||||
| NPI: | 1902474679 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OSANN | ||||||||
| FirstName: | NICHOLAS | ||||||||
| MiddleName: | DAVID | ||||||||
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| Credential: | PA-S | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8583 OAKHILL DR | ||||||||
| Address2: | |||||||||
| City: | FREELAND | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486238960 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7345463244 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1900 COLUMBUS AVE | ||||||||
| Address2: | |||||||||
| City: | BAY CITY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 487086880 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9898943000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2021 | ||||||||
| LastUpdateDate: | 11/07/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 5601010762 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.