Provider Demographics
NPI:1811369705
Name:OVERLAND, SHARIDAN (RN)
Entity Type:Individual
Prefix:
First Name:SHARIDAN
Middle Name:
Last Name:OVERLAND
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1224 E LOWELL ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85721-0400
Mailing Address - Country:US
Mailing Address - Phone:520-621-6493
Mailing Address - Fax:
Practice Address - Street 1:1224 E LOWELL ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85721-0400
Practice Address - Country:US
Practice Address - Phone:520-621-6493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-30
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN090086163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse