Healthcare Provider Details

I. General information

NPI: 1114807823
Provider Name (Legal Business Name): GRACE OVEREND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2025
Last Update Date: 11/02/2026
Certification Date: 11/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 E 2ND ST
DULUTH MN
55805-1906
US

IV. Provider business mailing address

3235 WATKINS SPUR
CLOQUET MN
55720-3320
US

V. Phone/Fax

Practice location:
  • Phone: 218-786-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number14553
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: