Provider Demographics
NPI:1760592042
Name:LIVINGSTON, LINDA C (CRNA)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:C
Last Name:LIVINGSTON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 LONG CREEK DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-2440
Mailing Address - Country:US
Mailing Address - Phone:207-879-0094
Mailing Address - Fax:207-879-0095
Practice Address - Street 1:25 LONG CREEK DR
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-2440
Practice Address - Country:US
Practice Address - Phone:207-879-0094
Practice Address - Fax:207-879-0095
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME17055367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM2115Medicare PIN