Provider Demographics
NPI:1497484315
Name:LIVERMORE, NICOLE ANN (APRN-CNS)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:ANN
Last Name:LIVERMORE
Suffix:
Gender:F
Credentials:APRN-CNS
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:ANN
Other - Last Name:MORRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1571 S 48TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-1226
Mailing Address - Country:US
Mailing Address - Phone:402-890-8047
Mailing Address - Fax:
Practice Address - Street 1:1571 S 48TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-1226
Practice Address - Country:US
Practice Address - Phone:402-890-8047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-07
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE114125364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health