Provider Demographics
NPI:1720113228
Name:ST JOSEPH LIVINGSTON HOSPITAL
Entity Type:Organization
Organization Name:ST JOSEPH LIVINGSTON HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NNP
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:ATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MSN
Authorized Official - Phone:847-530-3353
Mailing Address - Street 1:5473 HILLSBORO CT
Mailing Address - Street 2:
Mailing Address - City:COMMERCE TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48382-5135
Mailing Address - Country:US
Mailing Address - Phone:847-530-3353
Mailing Address - Fax:
Practice Address - Street 1:620 BYRON RD
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-1002
Practice Address - Country:US
Practice Address - Phone:517-545-6593
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704142694363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatalGroup - Single Specialty