Provider Demographics
NPI:1477799245
Name:LIVELY, HILDA ARDELLA (FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:HILDA
Middle Name:ARDELLA
Last Name:LIVELY
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4401 FLOWERTON ROAD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229-1510
Mailing Address - Country:US
Mailing Address - Phone:443-683-3025
Mailing Address - Fax:667-200-1186
Practice Address - Street 1:4401 FLOWERTON ROAD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-1510
Practice Address - Country:US
Practice Address - Phone:144-368-3302
Practice Address - Fax:667-200-1186
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-29
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR090530363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily