Provider Demographics
NPI:1477815181
Name:OVERFIELD, MARY LOUISE (MN, RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:LOUISE
Last Name:OVERFIELD
Suffix:
Gender:F
Credentials:MN, RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11608 RUTLEDGE BAY
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-9204
Mailing Address - Country:US
Mailing Address - Phone:919-847-4903
Mailing Address - Fax:
Practice Address - Street 1:11608 RUTLEDGE BAY
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-9204
Practice Address - Country:US
Practice Address - Phone:919-847-4903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-09
Last Update Date:2012-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC84348163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant