Provider Demographics
NPI:1740578343
Name:LIVINGSTON, MARJORIE RUTH (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:MARJORIE
Middle Name:RUTH
Last Name:LIVINGSTON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:717 COLLIER CT
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21158-9449
Mailing Address - Country:US
Mailing Address - Phone:478-250-7092
Mailing Address - Fax:
Practice Address - Street 1:1643 LIBERTY RD STE 105
Practice Address - Street 2:
Practice Address - City:ELDERSBURG
Practice Address - State:MD
Practice Address - Zip Code:21784-6545
Practice Address - Country:US
Practice Address - Phone:478-250-7092
Practice Address - Fax:443-863-6777
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-16
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR145196363LF0000X, 163W00000X
PASP012017363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse