Provider Demographics
NPI:1427130178
Name:LIVELY, JEANNETTE A (RN, MSN)
Entity type:Individual
Prefix:
First Name:JEANNETTE
Middle Name:A
Last Name:LIVELY
Suffix:
Gender:F
Credentials:RN, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 COOLIDGE ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:GREENEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37743-4672
Mailing Address - Country:US
Mailing Address - Phone:423-636-2300
Mailing Address - Fax:423-636-0348
Practice Address - Street 1:1021 COOLIDGE ST
Practice Address - Street 2:SUITE 2
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37743-4672
Practice Address - Country:US
Practice Address - Phone:423-636-2300
Practice Address - Fax:423-636-0348
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000120048176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1053402701OtherGROUP NPI
TN3661167Medicaid
TN3661167OtherMEDICARE PPIN
TN1427130178OtherNPI
TN3661167Medicaid