Provider Demographics
NPI:1336974849
Name:OVERTURF, ANNEKA (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:ANNEKA
Middle Name:
Last Name:OVERTURF
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:ANNEKA
Other - Middle Name:
Other - Last Name:OVERTURF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN, IBCLC
Mailing Address - Street 1:932 19TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98371-7312
Mailing Address - Country:US
Mailing Address - Phone:253-820-7271
Mailing Address - Fax:
Practice Address - Street 1:932 19TH AVE SW
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98371-7312
Practice Address - Country:US
Practice Address - Phone:253-820-7271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00173367163W00000X
WAL-152917163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163W00000XNursing Service ProvidersRegistered Nurse