Provider Demographics
NPI:1013024496
Name:OSBORNE, MICHELE M (CRNA-MNA)
Entity type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:M
Last Name:OSBORNE
Suffix:
Gender:F
Credentials:CRNA-MNA
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:M
Other - Last Name:WNUK
Other - Suffix:
Other - Last Name Type:Doing Business As
Other - Credentials:
Mailing Address - Street 1:PO BOX 735044
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-5044
Mailing Address - Country:US
Mailing Address - Phone:800-326-2250
Mailing Address - Fax:
Practice Address - Street 1:855 N WESTHAVEN DR
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54904
Practice Address - Country:US
Practice Address - Phone:920-303-8700
Practice Address - Fax:920-303-5630
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI111524-030367500000X
WI2070-033367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43383200Medicaid