Provider Demographics
NPI:1164724688
Name:LIVINGSTON-GREEN, DEBRA LANE (NP)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:LANE
Last Name:LIVINGSTON-GREEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:39 OFFICE PARK DR STE A
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-3220
Mailing Address - Country:US
Mailing Address - Phone:910-939-0724
Mailing Address - Fax:939-333-9145
Practice Address - Street 1:39 OFFICE PARK DR STE A
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-3220
Practice Address - Country:US
Practice Address - Phone:910-939-0724
Practice Address - Fax:939-333-9145
Is Sole Proprietor?:No
Enumeration Date:2010-12-04
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC91472363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6003101Medicaid
2595096Medicare PIN