Individual
NICOLE OSBORNE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
624 MARKET AVE N, CANTON, OH 44702
(330) 479-1912
(330) 479-1916
Mailing address
624 MARKET AVE N, CANTON, OH 44702-1017
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0191691
—
OH
Enumeration date
03/08/2018
Last updated
03/08/2018
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