Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 27746 | NE |
NPI | 1053569111 |
---|---|
Provider Name | Mr. Andrew Dale Livingston |
First Address | Lincoln, NE 68502-3762 |
Second Address | Lincoln, NE 68502-3762 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/09/2008 |
Last Update Date | 22/09/2014 |