Healthcare Provider Details

I. General information

NPI: 1376454348
Provider Name (Legal Business Name): RAEGANN OVERTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 2ND ST SE
MINOT ND
58701-3924
US

IV. Provider business mailing address

215 2ND ST SE
MINOT ND
58701-3924
US

V. Phone/Fax

Practice location:
  • Phone: 701-857-4400
  • Fax:
Mailing address:
  • Phone: 701-857-4400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR54665
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: