MEDICARE: ELIZABETH ANN OVERTON LM, CPM

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
1	176B00000X	Midwife	98020	TX

General Provider Information

NPI Number	:	1508971029
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH ANN OVERTON LM, CPM

Provider Business Mailing Address
First Line	:	939 AYERS ST
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78404-1915
Country	:	US
Telephone Number	:	361-882-4107
Fax Number	:	361-336-0202

Provider Business Practice Location Address
First Line	:	939 AYERS ST
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78404-1915
Country	:	US
Telephone Number	:	361-882-4107
Fax Number	:	361-336-0212

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	06/04/2020

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