Healthcare Provider Details

I. General information

NPI: 1760709760
Provider Name (Legal Business Name): LORRAINE DONELLA OVERGAARD RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2010
Last Update Date: 04/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 INDIAN HILLS DR
MACY NE
68039-3023
US

IV. Provider business mailing address

100 INDIAN HILLS DR
MACY NE
68039-3023
US

V. Phone/Fax

Practice location:
  • Phone: 402-837-5381
  • Fax: 402-837-5745
Mailing address:
  • Phone: 402-837-5381
  • Fax: 402-837-5745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number106315
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: