Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 4087 | OR |
N | 207Q00000X | Family Doctor | NT60413628 | WA |
NPI | 1053741728 |
---|---|
Provider Name | Emily Livengood |
First Address | Bend, OR 97709-1525 |
Second Address | Bend, OR 97702-3232 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2013 |
Last Update Date | 29/07/2021 |