Provider Demographics
NPI:1215290101
Name:KLEIN, LIVIA LEORA (ARNP)
Entity type:Individual
Prefix:
First Name:LIVIA
Middle Name:LEORA
Last Name:KLEIN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1734 SW WATERSTONE DR
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97527-6437
Mailing Address - Country:US
Mailing Address - Phone:813-404-9832
Mailing Address - Fax:
Practice Address - Street 1:1734 SW WATERSTONE DR
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97527-6437
Practice Address - Country:US
Practice Address - Phone:813-404-9832
Practice Address - Fax:541-226-2328
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-17
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201806310363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL013392800Medicaid
FLGT845X - PASCOMedicare PIN