Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 43770 | CO |
N | 207NS0135X | Procedural Dermatology | 43770 | CO |
NPI | 1013994367 |
---|---|
Provider Name | Dr. Jeanne Pruss Osborn |
First Address | Monument, CO 80132-2894 |
Second Address | Colorado Springs, CO 80920-7799 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2005 |
Last Update Date | 21/10/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
COA104343 | (02) |