Provider Demographics
NPI:1740414325
Name:FOLEY, LIVIA ANNE (RD)
Entity type:Individual
Prefix:MS
First Name:LIVIA
Middle Name:ANNE
Last Name:FOLEY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:LIVIA
Other - Middle Name:ANNE
Other - Last Name:WAGNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 421
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-0421
Mailing Address - Country:US
Mailing Address - Phone:509-474-6960
Mailing Address - Fax:509-227-7070
Practice Address - Street 1:105 W 8TH AVE STE 660E
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2302
Practice Address - Country:US
Practice Address - Phone:509-474-6960
Practice Address - Fax:509-227-7070
Is Sole Proprietor?:No
Enumeration Date:2009-05-11
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI00001924133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8881227Medicare PIN