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NPI Code Detail

MEDICARE: TAWANA N OVERTON NP

MEDICARE: TAWANA N OVERTON NP
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
1363L00000XNurse Practitioner2136778MN
2363LF0000XFamily Nurse Practitioner2136778MN
3363L00000XNurse Practitioner2227MN

General Provider Information

NPI Number : 1497195952
Entity Type Code : Individual
Provider Name (Legal Business Name) : TAWANA N OVERTON NP
Provider Business Mailing Address
First Line : 200 1ST ST SW
Second Line :
City : ROCHESTER
State : MN
Zip : 55905-0001
Country : US
Telephone Number : 507-284-2511
Fax Number :
Provider Business Practice Location Address
First Line : 200 1ST ST SW
Second Line :
City : ROCHESTER
State : MN
Zip : 55905-0001
Country : US
Telephone Number : 507-284-2511
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/28/2013
Last Update Date : 08/10/2020

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