Provider Demographics
NPI:1376501429
Name:LIVERMORE, URSULA C (MD)
Entity Type:Individual
Prefix:
First Name:URSULA
Middle Name:C
Last Name:LIVERMORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:URSULA
Other - Middle Name:C
Other - Last Name:JANNI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1690 ELM ST STE 300
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-3679
Mailing Address - Country:US
Mailing Address - Phone:563-690-2850
Mailing Address - Fax:563-582-5335
Practice Address - Street 1:1690 ELM ST STE 300
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-3679
Practice Address - Country:US
Practice Address - Phone:563-690-2850
Practice Address - Fax:563-582-5335
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01061204A207Q00000X
IA33221207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200541120Medicaid
IN814890VMedicare ID - Type Unspecified
IN200541120Medicaid