Provider Demographics
NPI:1861170409
Name:OVERTON, DESERENE LIN (MSN, APRN, FNP- BC)
Entity type:Individual
Prefix:
First Name:DESERENE
Middle Name:LIN
Last Name:OVERTON
Suffix:
Gender:F
Credentials:MSN, APRN, FNP- BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 LAKEVIEW DR # 952
Mailing Address - Street 2:
Mailing Address - City:FORT MONTGOMERY
Mailing Address - State:NY
Mailing Address - Zip Code:10922-7731
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9 LAKEVIEW DR # 952
Practice Address - Street 2:
Practice Address - City:FORT MONTGOMERY
Practice Address - State:NY
Practice Address - Zip Code:10922-7731
Practice Address - Country:US
Practice Address - Phone:914-752-8354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-05
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY352396363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily