Provider Demographics
NPI:1285109207
Name:LIVINGSTON, JULIE (RN)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:LIVINGSTON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1012 5TH AVE S
Mailing Address - Street 2:
Mailing Address - City:CLEAR LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:50428-3826
Mailing Address - Country:US
Mailing Address - Phone:641-355-3652
Mailing Address - Fax:
Practice Address - Street 1:THRIFTY WHITE DRUG
Practice Address - Street 2:1907 US HIGHWAY 18 EAST
Practice Address - City:CLEAR LAKE
Practice Address - State:IA
Practice Address - Zip Code:50428
Practice Address - Country:US
Practice Address - Phone:641-357-5271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-05
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA046471163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse