Provider Demographics
NPI:1497056642
Name:LIVINGSTON, AMY MARIE (ANP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MARIE
Last Name:LIVINGSTON
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:M
Other - Last Name:NECZYPOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ANP
Mailing Address - Street 1:PO BOX 781389
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48278-1389
Mailing Address - Country:US
Mailing Address - Phone:440-918-4690
Mailing Address - Fax:440-918-4694
Practice Address - Street 1:4176 STATE ROUTE 306
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-9203
Practice Address - Country:US
Practice Address - Phone:440-918-4690
Practice Address - Fax:440-918-4694
Is Sole Proprietor?:No
Enumeration Date:2010-11-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH11970-NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3103171Medicaid
OHRN 325805OtherCERTIFICATE OF AUTHORITY
OHRN 325805OtherCERTIFICATE OF AUTHORITY