Healthcare Provider Details

I. General information

NPI: 1346020641
Provider Name (Legal Business Name): DANIELLE OVERTON-MILLER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2023
Last Update Date: 10/03/2023
Certification Date: 10/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 WH SMITH BLVD
GREENVILLE NC
27834-3752
US

IV. Provider business mailing address

460 CLEARWATER DR NW
CONCORD NC
28027-3806
US

V. Phone/Fax

Practice location:
  • Phone: 910-323-1545
  • Fax:
Mailing address:
  • Phone: 716-846-9121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number404204
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: