Provider Demographics
NPI:1639448749
Name:OVERHOLSER HOVLAND, KAREN LYNN (RN, PHN)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:LYNN
Last Name:OVERHOLSER HOVLAND
Suffix:
Gender:F
Credentials:RN, PHN
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:LYNN
Other - Last Name:OVERHOLSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN,PHN
Mailing Address - Street 1:500 3RD AVE SE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PINE CITY
Mailing Address - State:MN
Mailing Address - Zip Code:55063
Mailing Address - Country:US
Mailing Address - Phone:320-629-6674
Mailing Address - Fax:320-629-6630
Practice Address - Street 1:500 3RD AVE SE
Practice Address - Street 2:SUITE 2
Practice Address - City:PINE CITY
Practice Address - State:MN
Practice Address - Zip Code:55063
Practice Address - Country:US
Practice Address - Phone:320-629-6674
Practice Address - Fax:320-629-6630
Is Sole Proprietor?:No
Enumeration Date:2011-12-19
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR129610-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse