Basic Information
Provider Information
NPI: 1003004573
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: OSETSKY
FirstName: JOANNE
MiddleName: LYNN
NamePrefix: MRS.
NameSuffix:  
Credential: ARNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 25608
Address2:  
City: SALT LAKE CITY
State: UT
PostalCode: 841250608
CountryCode: US
TelephoneNumber: 2063204476
FaxNumber: 2065687043
Practice Location
Address1: 550 17TH AVE
Address2: STE 110
City: SEATTLE
State: WA
PostalCode: 981225788
CountryCode: US
TelephoneNumber: 2063203470
FaxNumber: 2063203471
Other Information
ProviderEnumerationDate: 10/10/2007
LastUpdateDate: 07/07/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363L00000XAP60525658WAY Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 
363L00000XARNP2791032FLN Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 

No ID Information.


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