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NPI Code Detail

MEDICARE: DANETTE OVERSTREET CRNP

MEDICARE: DANETTE OVERSTREET CRNP
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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner1-026668AL

General Provider Information

NPI Number : 1720080179
Entity Type Code : Individual
Provider Name (Legal Business Name) : DANETTE OVERSTREET CRNP
Provider Business Mailing Address
First Line : 5750A SOUTHLAND DR
Second Line :
City : MOBILE
State : AL
Zip : 36693-3316
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5800 SOUTHLAND DR
Second Line :
City : MOBILE
State : AL
Zip : 36693-3313
Country : US
Telephone Number : 251-662-8050
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/15/2005
Last Update Date : 07/08/2007

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