Provider Demographics
NPI:1245062264
Name:LIVERMORE, ABIGAIL GENE
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:GENE
Last Name:LIVERMORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6617 US HIGHWAY 20
Mailing Address - Street 2:
Mailing Address - City:WAKEMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44889-9277
Mailing Address - Country:US
Mailing Address - Phone:440-420-8799
Mailing Address - Fax:
Practice Address - Street 1:6617 US HIGHWAY 20
Practice Address - Street 2:
Practice Address - City:WAKEMAN
Practice Address - State:OH
Practice Address - Zip Code:44889-9277
Practice Address - Country:US
Practice Address - Phone:440-420-8799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty