Provider Demographics
NPI:1063234953
Name:OSBY, JEANETTE (LPT)
Entity type:Individual
Prefix:
First Name:JEANETTE
Middle Name:
Last Name:OSBY
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2651 26TH ST APT 14
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95818-2652
Mailing Address - Country:US
Mailing Address - Phone:916-968-2525
Mailing Address - Fax:
Practice Address - Street 1:2651 26TH ST APT 14
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95818-2652
Practice Address - Country:US
Practice Address - Phone:916-968-2525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-30
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT32738167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician