Provider Demographics
NPI:1497872279
Name:OVERSLAUGH, MARION ELIZABETH (RN,CCM)
Entity Type:Individual
Prefix:MS
First Name:MARION
Middle Name:ELIZABETH
Last Name:OVERSLAUGH
Suffix:
Gender:F
Credentials:RN,CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 VILLAGE TRL
Mailing Address - Street 2:
Mailing Address - City:HONEOYE FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14472-1034
Mailing Address - Country:US
Mailing Address - Phone:585-624-4731
Mailing Address - Fax:
Practice Address - Street 1:28 VILLAGE TRL
Practice Address - Street 2:
Practice Address - City:HONEOYE FALLS
Practice Address - State:NY
Practice Address - Zip Code:14472-1034
Practice Address - Country:US
Practice Address - Phone:585-624-4731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY242306-1163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02782185Medicaid