MEDICARE: VICTORIA OVERCOMER APRN FNP-C

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	164W00000X	Licensed Practical Nurse	117522	OH
2	363LF0000X	Family Nurse Practitioner	F06162475	OH
3	163W00000X	Registered Nurse	RN 368023	OH

General Provider Information

NPI Number	:	1285698894
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORIA OVERCOMER APRN FNP-C

Provider Business Mailing Address
First Line	:	5298 PRATER DR
Second Line	:
City	:	GROVEPORT
State	:	OH
Zip	:	43125-9137
Country	:	US
Telephone Number	:	614-592-8269
Fax Number	:	614-223-1732

Provider Business Practice Location Address
First Line	:	5797 BEECHCROFT RD STE F
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43229-2758
Country	:	US
Telephone Number	:	614-500-2500
Fax Number	:	614-369-3723

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

Provider Enumeration Date	:	04/12/2006
Last Update Date	:	01/23/2019

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