Provider Demographics
NPI:1184845240
Name:LIVELY, NANCY DANIELSON
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:DANIELSON
Last Name:LIVELY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 NORTH SHORE DR
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND VILLAGE
Mailing Address - State:TX
Mailing Address - Zip Code:75077
Mailing Address - Country:US
Mailing Address - Phone:972-318-0545
Mailing Address - Fax:
Practice Address - Street 1:1800 W. CHESTNUT
Practice Address - Street 2:102
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76203-5160
Practice Address - Country:US
Practice Address - Phone:940-565-2798
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18848183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist