Provider Demographics
NPI:1437369485
Name:LIVINGSTON, PEGGY ANN (RN BSN)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:ANN
Last Name:LIVINGSTON
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 WEDGEWOOD DR
Mailing Address - Street 2:# 3
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-2434
Mailing Address - Country:US
Mailing Address - Phone:402-641-5466
Mailing Address - Fax:
Practice Address - Street 1:115 WEDGEWOOD DR
Practice Address - Street 2:# 3
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-2434
Practice Address - Country:US
Practice Address - Phone:402-641-5466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE60885251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEH12123018OtherDRIVERS LISC