Provider Demographics
NPI:1285713396
Name:LIVINGSTON, MYLYNDA S (RN CNP)
Entity type:Individual
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First Name:MYLYNDA
Middle Name:S
Last Name:LIVINGSTON
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Gender:F
Credentials:RN CNP
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Mailing Address - Street 1:2910 CENTRE POINTE DRIVE
Mailing Address - Street 2:CHILDRENS HEALTH CARE 35 121A
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113
Mailing Address - Country:US
Mailing Address - Phone:651-855-2327
Mailing Address - Fax:651-855-2310
Practice Address - Street 1:347 NORTH SMITH AVENUE
Practice Address - Street 2:CHILDRENS SPECIALTY CLINIC HEMATOLOGY ONCOLOGY STPL
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102
Practice Address - Country:US
Practice Address - Phone:651-220-6732
Practice Address - Fax:651-220-6005
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2012-09-19
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Provider Licenses
StateLicense IDTaxonomies
MNR1465987363L00000X, 363LP0200X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN433657000Medicaid