Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 041-348378 | IL |
NPI | 1043776958 |
---|---|
Provider Name | Julie Michelle Livingston |
First Address | Springfield, IL 62794-9676 |
Second Address | Springfield, IL 62702-5303 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2019 |
Last Update Date | 15/02/2019 |