Provider Demographics
NPI:1487121711
Name:LIVENGOOD, ELISA R (RN)
Entity type:Individual
Prefix:
First Name:ELISA
Middle Name:R
Last Name:LIVENGOOD
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 1:1661 COUNTY ROAD 170
Mailing Address - Street 2:
Mailing Address - City:WESTCLIFFE
Mailing Address - State:CO
Mailing Address - Zip Code:81252-9168
Mailing Address - Country:US
Mailing Address - Phone:719-371-0910
Mailing Address - Fax:
Practice Address - Street 1:1661 COUNTY ROAD 170
Practice Address - Street 2:
Practice Address - City:WESTCLIFFE
Practice Address - State:CO
Practice Address - Zip Code:81252-9168
Practice Address - Country:US
Practice Address - Phone:719-371-0910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-24
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0176769163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse