Provider Demographics
NPI:1326189796
Name:LIVEZEY, MARIE LUCILLE (CST CFA)
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:LUCILLE
Last Name:LIVEZEY
Suffix:
Gender:F
Credentials:CST CFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 571034
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74157
Mailing Address - Country:US
Mailing Address - Phone:918-445-0671
Mailing Address - Fax:918-587-1767
Practice Address - Street 1:1809 E. 13TH ST
Practice Address - Street 2:SUITE 400
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104
Practice Address - Country:US
Practice Address - Phone:918-599-8200
Practice Address - Fax:918-587-1767
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK94845246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist