Provider Demographics
NPI:1508133679
Name:LIVINGSTON, D'NICOLE (NP)
Entity Type:Individual
Prefix:MS
First Name:D'NICOLE
Middle Name:
Last Name:LIVINGSTON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:D'NICOLE
Other - Middle Name:
Other - Last Name:KREIZENBECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:3340 E GOLDSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1026
Mailing Address - Country:US
Mailing Address - Phone:208-302-0700
Mailing Address - Fax:208-302-0755
Practice Address - Street 1:1000 N CURTIS ROAD
Practice Address - Street 2:STE 305
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706
Practice Address - Country:US
Practice Address - Phone:208-302-0700
Practice Address - Fax:208-302-0755
Is Sole Proprietor?:No
Enumeration Date:2011-11-17
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP-1101A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily