Provider Demographics
NPI:1942825930
Name:LIVINGSTON, MEGHAN (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:
Last Name:LIVINGSTON
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:MEGHAN
Other - Middle Name:JOSEPHINE
Other - Last Name:PAGELS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2695 ROCKY MOUNTAIN AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-9071
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2500 ROCKY MOUNTAIN AVE STE 100
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-9004
Practice Address - Country:US
Practice Address - Phone:970-624-1800
Practice Address - Fax:970-624-1891
Is Sole Proprietor?:No
Enumeration Date:2020-06-15
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10003006A363A00000X
COPA.0006353363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant