Provider Demographics
NPI:1316058316
Name:OSBORN, JUDITH H (NP)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:H
Last Name:OSBORN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 S SHARON AMITY RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-2975
Mailing Address - Country:US
Mailing Address - Phone:704-384-8800
Mailing Address - Fax:704-384-8819
Practice Address - Street 1:517 S SHARON AMITY RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-2975
Practice Address - Country:US
Practice Address - Phone:704-384-8800
Practice Address - Fax:704-384-8819
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200274363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCS93918Medicare UPIN
NC2599104AMedicare ID - Type Unspecified