Provider Demographics
NPI:1023310547
Name:LIVINGSTON, LYNETTE (RN,MSN)
Entity type:Individual
Prefix:MS
First Name:LYNETTE
Middle Name:
Last Name:LIVINGSTON
Suffix:
Gender:F
Credentials:RN,MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11818 221ST ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIA HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11411-2013
Mailing Address - Country:US
Mailing Address - Phone:718-210-8960
Mailing Address - Fax:
Practice Address - Street 1:205 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6022
Practice Address - Country:US
Practice Address - Phone:718-732-7171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-04
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY380598-1163WA2000X, 163WG0600X, 163WM0705X, 163WP2201X, 302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163WG0600XNursing Service ProvidersRegistered NurseGerontology
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care