Provider Demographics
NPI:1740723188
Name:OVERLAND, HEATHER L (NMD, LAC)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:L
Last Name:OVERLAND
Suffix:
Gender:F
Credentials:NMD, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 W CAPSTONE CT STE B
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-8774
Mailing Address - Country:US
Mailing Address - Phone:208-295-9778
Mailing Address - Fax:509-992-1101
Practice Address - Street 1:660 W CAPSTONE CT STE B
Practice Address - Street 2:
Practice Address - City:HAYDEN
Practice Address - State:ID
Practice Address - Zip Code:83835-8774
Practice Address - Country:US
Practice Address - Phone:208-295-9778
Practice Address - Fax:208-213-9369
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-01
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID427171100000X
ORAC179695171100000X
WAAC 60705361171100000X
MTMED-ACU-LIC-66544171100000X
IDNMD-0028175F00000X
WANT 60705355175F00000X
OR4043175F00000X
MTACH-NAT-LIC-1627175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist