Provider Demographics
NPI:1124504980
Name:OVERDORF, KAREN LEIGH (LPN)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:LEIGH
Last Name:OVERDORF
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3358 STATE ROUTE 19 N
Mailing Address - Street 2:
Mailing Address - City:WELLSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14895-9542
Mailing Address - Country:US
Mailing Address - Phone:585-610-8853
Mailing Address - Fax:
Practice Address - Street 1:3358 STATE ROUTE 19 N
Practice Address - Street 2:
Practice Address - City:WELLSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14895-9542
Practice Address - Country:US
Practice Address - Phone:585-610-8853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-16
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY258518251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0521Medicaid