Provider Demographics
NPI:1508971029
Name:OVERTON, ELIZABETH ANN (LM, CPM)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANN
Last Name:OVERTON
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:
Other - Last Name:OVERTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LM, CPM
Mailing Address - Street 1:939 AYERS ST
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78404-1915
Mailing Address - Country:US
Mailing Address - Phone:361-882-4107
Mailing Address - Fax:361-336-0202
Practice Address - Street 1:939 AYERS ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-1915
Practice Address - Country:US
Practice Address - Phone:361-882-4107
Practice Address - Fax:361-336-0212
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX98020176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife