Provider Demographics
NPI:1417648684
Name:OVERHOLT, HUMAIRA CAROLINE
Entity Type:Individual
Prefix:
First Name:HUMAIRA
Middle Name:CAROLINE
Last Name:OVERHOLT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 CHAMA ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-7119
Mailing Address - Country:US
Mailing Address - Phone:505-227-6565
Mailing Address - Fax:
Practice Address - Street 1:1313 CHAMA ST NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-7119
Practice Address - Country:US
Practice Address - Phone:505-227-6565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-17
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health