Provider Demographics
NPI:1336303577
Name:OVERLY, WAYNE DAVID (CNS)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:DAVID
Last Name:OVERLY
Suffix:
Gender:M
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10406 WILD ORCHID WAY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-2876
Mailing Address - Country:US
Mailing Address - Phone:858-254-0568
Mailing Address - Fax:
Practice Address - Street 1:VA SAN DIEGO HEALTHCARE SYSTEM
Practice Address - Street 2:3350 LA JOLLA VILLAGE DRIVE
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92161-0001
Practice Address - Country:US
Practice Address - Phone:858-552-8585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA501535163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency