Healthcare Provider Details

I. General information

NPI: 1811209695
Provider Name (Legal Business Name): ANDREA MARIE OVERTURF NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANDREA MARIE REYNOLDS

II. Dates (important events)

Enumeration Date: 07/08/2010
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 MAPLE ROAD SUITE 100
WILLIAMSVILLE NY
14221-2749
US

IV. Provider business mailing address

101 ST. CLARE TERRACE
TONAWANDA NY
14150
US

V. Phone/Fax

Practice location:
  • Phone: 716-636-5437
  • Fax: 716-276-3190
Mailing address:
  • Phone: 716-316-0722
  • Fax: 716-276-3190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN9278522
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number382141
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberARNP9278522
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number16129
License Number StateCT
# 5
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberAPRN9278522
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: