Provider Demographics
NPI:1528447075
Name:OSBORNE, LIAUDRIANN
Entity type:Individual
Prefix:
First Name:LIAUDRIANN
Middle Name:
Last Name:OSBORNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3561 ROUTE 32 APT 4
Mailing Address - Street 2:
Mailing Address - City:SAUGERTIES
Mailing Address - State:NY
Mailing Address - Zip Code:12477-4091
Mailing Address - Country:US
Mailing Address - Phone:845-217-5049
Mailing Address - Fax:
Practice Address - Street 1:3561 ROUTE 32 APT 4
Practice Address - Street 2:
Practice Address - City:SAUGERTIES
Practice Address - State:NY
Practice Address - Zip Code:12477-4091
Practice Address - Country:US
Practice Address - Phone:845-217-5049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-29
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY311769-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse