Provider Demographics
NPI:1356503189
Name:OVERMYER, VICKI (FNP)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:
Last Name:OVERMYER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8466 WEST PAUS RD.
Mailing Address - Street 2:
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46360-3563
Mailing Address - Country:US
Mailing Address - Phone:219-873-2082
Mailing Address - Fax:219-873-2222
Practice Address - Street 1:8466 W PAHS RD
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-2919
Practice Address - Country:US
Practice Address - Phone:219-873-2082
Practice Address - Fax:219-873-2222
Is Sole Proprietor?:No
Enumeration Date:2008-07-02
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001642A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN71001642AOtherNURSE PRACTITIONER