Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 1449 | WV |
NPI | 1003824640 |
---|---|
Provider Name | Cynthia M Osborne |
First Address | Craigsville, WV 26205-0946 |
Second Address | Craigsville, WV 26205-3102 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0046926000 | (05) | WV |
G36578 | (02) | WV |