Provider Demographics
NPI:1588913727
Name:OSBORN, ANNIE (LAC)
Entity type:Individual
Prefix:
First Name:ANNIE
Middle Name:
Last Name:OSBORN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4527 MONTGOMERY DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95409-5363
Mailing Address - Country:US
Mailing Address - Phone:707-547-0500
Mailing Address - Fax:
Practice Address - Street 1:4527 MONTGOMERY DR
Practice Address - Street 2:SUITE A
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95409-5363
Practice Address - Country:US
Practice Address - Phone:707-547-0500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-04
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC6836171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist