Provider Demographics
NPI:1205513066
Name:OVERMYER, EMMA CATHERINE
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:CATHERINE
Last Name:OVERMYER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:EMMA
Other - Middle Name:CATHERINE
Other - Last Name:NOLAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1222 ARBOR LN
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46544-5876
Mailing Address - Country:US
Mailing Address - Phone:574-350-4158
Mailing Address - Fax:
Practice Address - Street 1:901 W NEW YORK ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5224
Practice Address - Country:US
Practice Address - Phone:317-274-7238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-03
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN363A00000X
IN10004193A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant