Basic Information
| Provider Information | |||||||||
| NPI: | 1134761687 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OVERTON | ||||||||
| FirstName: | MARCIA | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | |||||||||
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| Credential: | MEDICAL ASSISTANT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4600 3RD ST | ||||||||
| Address2: | |||||||||
| City: | MOLINE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 612656106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3097793924 | ||||||||
| FaxNumber: | 3097792167 | ||||||||
| Practice Location | |||||||||
| Address1: | 4600 3RD ST | ||||||||
| Address2: | |||||||||
| City: | MOLINE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 612656106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3097793987 | ||||||||
| FaxNumber: | 3097792167 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2019 | ||||||||
| LastUpdateDate: | 10/16/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 376K00000X | Y | Nursing Service Related Providers | Nurse's Aide |
No ID Information.