Provider Demographics
NPI:1619953288
Name:LIVGARD, FRANCESCA JOLINE (PA-C)
Entity Type:Individual
Prefix:
First Name:FRANCESCA
Middle Name:JOLINE
Last Name:LIVGARD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:FRANCES
Other - Middle Name:JOLINE
Other - Last Name:AMDAHL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:701 HEWITT BLVD
Mailing Address - Street 2:
Mailing Address - City:RED WING
Mailing Address - State:MN
Mailing Address - Zip Code:55066-2848
Mailing Address - Country:US
Mailing Address - Phone:651-267-5000
Mailing Address - Fax:
Practice Address - Street 1:701 HEWITT BLVD
Practice Address - Street 2:
Practice Address - City:RED WING
Practice Address - State:MN
Practice Address - Zip Code:55066-2848
Practice Address - Country:US
Practice Address - Phone:651-267-3523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9605207X00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN96637100Medicaid
MNENROLLEDMedicaid
MNP00849734OtherMEDICARE RAILROAD
P36205Medicare UPIN
MNP00849734OtherMEDICARE RAILROAD
970001523Medicare ID - Type Unspecified