Provider Demographics
NPI:1578644050
Name:OSBORN, PENNY R (PA)
Entity type:Individual
Prefix:MS
First Name:PENNY
Middle Name:R
Last Name:OSBORN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:PENNY
Other - Middle Name:R
Other - Last Name:OSBORN-SLINGS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-
Mailing Address - Street 1:913 BYRON ST
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:IA
Mailing Address - Zip Code:50249-7759
Mailing Address - Country:US
Mailing Address - Phone:515-360-1006
Mailing Address - Fax:
Practice Address - Street 1:817 SHAKESPEARE AVE
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:IA
Practice Address - Zip Code:50249-7774
Practice Address - Country:US
Practice Address - Phone:515-838-2100
Practice Address - Fax:515-838-2193
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1059363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAS36540Medicare UPIN
IAI16131Medicare ID - Type Unspecified