Provider Demographics
NPI:1215106927
Name:OSBORNE, EARTHA JACKSON (L V N)
Entity type:Individual
Prefix:MS
First Name:EARTHA
Middle Name:JACKSON
Last Name:OSBORNE
Suffix:
Gender:F
Credentials:L V N
Other - Prefix:MS
Other - First Name:EARTHA
Other - Middle Name:OSBORNE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LVN
Mailing Address - Street 1:8225 RANCH RD.
Mailing Address - Street 2:FM 620 N. APT. # 2112
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78726-4170
Mailing Address - Country:US
Mailing Address - Phone:512-373-8229
Mailing Address - Fax:
Practice Address - Street 1:8225 RANCH RD 620 N APT 2112
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78726-4170
Practice Address - Country:US
Practice Address - Phone:512-373-8229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-27
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX127237164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001002501OtherMDCP