Provider Demographics
NPI:1255653994
Name:LIVINGSTON, EMILY SUE (FNP)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:SUE
Last Name:LIVINGSTON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2033 MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:SC
Mailing Address - Zip Code:29108-2249
Mailing Address - Country:US
Mailing Address - Phone:803-276-5188
Mailing Address - Fax:
Practice Address - Street 1:2033 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:NEWBERRY
Practice Address - State:SC
Practice Address - Zip Code:29108-2249
Practice Address - Country:US
Practice Address - Phone:803-276-5188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-22
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3237363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily