MEDICARE: SUNNILEE OVERCASH APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	8635969-8900	UT
2	363LF0000X	Family Nurse Practitioner	8635969-4405	UT

General Provider Information

NPI Number	:	1174392658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUNNILEE OVERCASH APRN

Provider Business Mailing Address
First Line	:	746 E WINCHESTER ST
Second Line	:
City	:	MURRAY
State	:	UT
Zip	:	84107-8512
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	746 E WINCHESTER ST
Second Line	:
City	:	MURRAY
State	:	UT
Zip	:	84107-8512
Country	:	US
Telephone Number	:	801-654-0443
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/26/2023
Last Update Date	:	12/26/2023

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