Provider Demographics
NPI:1477766319
Name:LIVELY, CORI C (LM, CPM)
Entity Type:Individual
Prefix:
First Name:CORI
Middle Name:C
Last Name:LIVELY
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2309 VALLEY CREEK DR
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75040-2845
Mailing Address - Country:US
Mailing Address - Phone:214-755-6086
Mailing Address - Fax:866-390-2510
Practice Address - Street 1:2309 VALLEY CREEK DR
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75040-2845
Practice Address - Country:US
Practice Address - Phone:214-755-6086
Practice Address - Fax:866-390-2510
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX99029176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife