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NPI Code Detail

MEDICARE: STEPHANIE NICOLE OVERMAN NP

MEDICARE: STEPHANIE NICOLE OVERMAN NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse Practitioner71003726AIN

General Provider Information

NPI Number : 1083999627
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHANIE NICOLE OVERMAN NP
Provider Business Mailing Address
First Line : 3702 NEW VISION DR
Second Line : BLDG B
City : FORT WAYNE
State : IN
Zip : 46845-1703
Country : US
Telephone Number : 260-563-7421
Fax Number : 260-563-7725
Provider Business Practice Location Address
First Line : 1025 MANCHESTER AVE
Second Line :
City : WABASH
State : IN
Zip : 46992-1425
Country : US
Telephone Number : 260-563-7421
Fax Number : 260-563-7725
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/14/2011
Last Update Date : 06/29/2018

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