Provider Demographics
NPI:1063540896
Name:OSBURN, AMANDA EVE (STNA)
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:EVE
Last Name:OSBURN
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 755
Mailing Address - Street 2:
Mailing Address - City:CONNEAUT
Mailing Address - State:OH
Mailing Address - Zip Code:44030-0755
Mailing Address - Country:US
Mailing Address - Phone:440-344-3078
Mailing Address - Fax:440-599-7330
Practice Address - Street 1:402 BROAD ST
Practice Address - Street 2:
Practice Address - City:CONNEAUT
Practice Address - State:OH
Practice Address - Zip Code:44030-2408
Practice Address - Country:US
Practice Address - Phone:440-344-3078
Practice Address - Fax:440-599-7339
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2554865374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide