Healthcare Provider Details

I. General information

NPI: 1356503189
Provider Name (Legal Business Name): VICKI OVERMYER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2008
Last Update Date: 04/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8466 W PAHS RD
MICHIGAN CITY IN
46360-2919
US

IV. Provider business mailing address

8466 WEST PAUS RD.
MICHIGAN CITY IN
46360-3563
US

V. Phone/Fax

Practice location:
  • Phone: 219-873-2082
  • Fax: 219-873-2222
Mailing address:
  • Phone: 219-873-2082
  • Fax: 219-873-2222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71001642A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: