Provider Demographics
NPI:1982925061
Name:OVERTON, BETTY J (LPN)
Entity type:Individual
Prefix:MS
First Name:BETTY
Middle Name:J
Last Name:OVERTON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:BETTY
Other - Middle Name:J
Other - Last Name:OVERTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:221 PINE ST
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-1448
Mailing Address - Country:US
Mailing Address - Phone:419-575-3650
Mailing Address - Fax:
Practice Address - Street 1:221 PINE ST
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-1448
Practice Address - Country:US
Practice Address - Phone:419-575-3650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-12
Last Update Date:2010-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 101827164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse