Provider Demographics
NPI:1467700161
Name:SLIVINGSTON, NP, LLC.
Entity Type:Organization
Organization Name:SLIVINGSTON, NP, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUSANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:LIVINGSTON
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:520-333-9354
Mailing Address - Street 1:310 N WILMOT RD
Mailing Address - Street 2:SUITE 307
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-2618
Mailing Address - Country:US
Mailing Address - Phone:520-333-9354
Mailing Address - Fax:520-441-2557
Practice Address - Street 1:310 N WILMOT RD
Practice Address - Street 2:SUITE 307
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-2618
Practice Address - Country:US
Practice Address - Phone:520-333-9354
Practice Address - Fax:520-441-2557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-28
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN027634207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ760662Medicaid