Provider Demographics
NPI:1528699030
Name:LIVELY, ANGELA MAE (LVN)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:MAE
Last Name:LIVELY
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:253 SHORT STREET
Mailing Address - Street 2:
Mailing Address - City:FORESTBURG
Mailing Address - State:TX
Mailing Address - Zip Code:76239
Mailing Address - Country:US
Mailing Address - Phone:940-284-0893
Mailing Address - Fax:
Practice Address - Street 1:253 SHORT STREET
Practice Address - Street 2:
Practice Address - City:FORESTBURG
Practice Address - State:TX
Practice Address - Zip Code:76239
Practice Address - Country:US
Practice Address - Phone:940-284-0893
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-03
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX163630164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse