Provider Demographics
NPI:1083999627
Name:OVERMAN, STEPHANIE NICOLE (NP)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:NICOLE
Last Name:OVERMAN
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:3702 NEW VISION DR
Mailing Address - Street 2:BLDG B
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1703
Mailing Address - Country:US
Mailing Address - Phone:260-563-7421
Mailing Address - Fax:260-563-7725
Practice Address - Street 1:1025 MANCHESTER AVE
Practice Address - Street 2:
Practice Address - City:WABASH
Practice Address - State:IN
Practice Address - Zip Code:46992-1425
Practice Address - Country:US
Practice Address - Phone:260-563-7421
Practice Address - Fax:260-563-7725
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-14
Last Update Date:2018-06-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN71003726A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner