Provider Demographics
NPI:1487260311
Name:LIVING, DORIA (PNP)
Entity type:Individual
Prefix:
First Name:DORIA
Middle Name:
Last Name:LIVING
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 80 BOX 15278
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96367-0055
Mailing Address - Country:US
Mailing Address - Phone:404-362-7211
Mailing Address - Fax:
Practice Address - Street 1:USHNO
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96367
Practice Address - Country:US
Practice Address - Phone:098-971-9355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-16
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA199069163WE0003X, 163WN0002X
TX1636008208000000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WE0003XNursing Service ProvidersRegistered NurseEmergency
No163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care
No208000000XAllopathic & Osteopathic PhysiciansPediatrics