Provider Demographics
NPI:1831180488
Name:OVERLAND, SALLY A (PA-C)
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:A
Last Name:OVERLAND
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SALLY
Other - Middle Name:ANN
Other - Last Name:DIGHTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:705 8TH ST
Mailing Address - Street 2:
Mailing Address - City:STORY CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50248-1301
Mailing Address - Country:US
Mailing Address - Phone:515-733-5191
Mailing Address - Fax:515-733-5354
Practice Address - Street 1:705 8TH ST
Practice Address - Street 2:
Practice Address - City:STORY CITY
Practice Address - State:IA
Practice Address - Zip Code:50248-1301
Practice Address - Country:US
Practice Address - Phone:515-733-5191
Practice Address - Fax:515-733-5354
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA000818363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAR03200Medicare UPIN
IA42679Medicare ID - Type Unspecified