Provider Demographics
NPI:1285065078
Name:OSBORNE, LISA (CRNP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:OSBORNE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1126 MCVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BOAZ
Mailing Address - State:AL
Mailing Address - Zip Code:35957-6029
Mailing Address - Country:US
Mailing Address - Phone:256-558-5480
Mailing Address - Fax:256-376-8102
Practice Address - Street 1:420 4TH ST NW
Practice Address - Street 2:
Practice Address - City:ATTALLA
Practice Address - State:AL
Practice Address - Zip Code:35954-2227
Practice Address - Country:US
Practice Address - Phone:256-690-0434
Practice Address - Fax:256-376-8102
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-05
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1117921363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily