Provider Demographics
NPI:1750573077
Name:LIVERANCE, MONICA
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:LIVERANCE
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 1:8444 WILDCAT RD
Mailing Address - Street 2:
Mailing Address - City:JEDDO
Mailing Address - State:MI
Mailing Address - Zip Code:48032-1814
Mailing Address - Country:US
Mailing Address - Phone:810-388-1200
Mailing Address - Fax:
Practice Address - Street 1:7363 JEDDO RD
Practice Address - Street 2:
Practice Address - City:GRANT TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48032-1006
Practice Address - Country:US
Practice Address - Phone:810-388-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-10
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant