Provider Demographics
NPI:1316112048
Name:OSAZUWA, KATHRYN M (NP)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:M
Last Name:OSAZUWA
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 1:386 EASTERN AVE # 2
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01902-1628
Mailing Address - Country:US
Mailing Address - Phone:781-316-4432
Mailing Address - Fax:
Practice Address - Street 1:200 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BOXFORD
Practice Address - State:MA
Practice Address - Zip Code:01921-1017
Practice Address - Country:US
Practice Address - Phone:978-296-3871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-23
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA269405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily