Provider Demographics
NPI:1578919023
Name:LIVOUS, WENDY
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:LIVOUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4901 WINNEBAGO ST
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70805-6170
Mailing Address - Country:US
Mailing Address - Phone:225-288-0938
Mailing Address - Fax:225-778-5664
Practice Address - Street 1:4901 WINNEBAGO ST
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70805-6170
Practice Address - Country:US
Practice Address - Phone:225-288-0938
Practice Address - Fax:225-778-5664
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-13
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA0044884556343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA81-2599339OtherFEDERAL TAX ID