Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | 25MP00277600 | NJ |
NPI | 1295007052 |
---|---|
Provider Name | Bernadette Livewell |
First Address | Mount Laurel, NJ 08054-1110 |
Second Address | Mount Laurel, NJ 08054-1110 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2012 |
Last Update Date | 23/10/2013 |