Basic Information
| Provider Information | |||||||||
| NPI: | 1972648111 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OVERKO | ||||||||
| FirstName: | LINDSAY | ||||||||
| MiddleName: | L. | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | PA-C | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | LABORE | ||||||||
| OtherFirstName: | LINDSAY | ||||||||
| OtherMiddleName: | LEIGH | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 4 CRESCENT ST | ||||||||
| Address2: | |||||||||
| City: | PENACOOK | ||||||||
| State: | NH | ||||||||
| PostalCode: | 033031412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6037534302 | ||||||||
| FaxNumber: | 6037536213 | ||||||||
| Practice Location | |||||||||
| Address1: | 4 CRESCENT ST | ||||||||
| Address2: | |||||||||
| City: | PENACOOK | ||||||||
| State: | NH | ||||||||
| PostalCode: | 033031412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6037534302 | ||||||||
| FaxNumber: | 6037536213 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2007 | ||||||||
| LastUpdateDate: | 01/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | 0839 | NH | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical | 2255A2300X | 0325 | NH | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer | 363A00000X | 0839 | NH | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 3075343 | 05 | NH | MEDICAID |