Provider Demographics
NPI:1780308932
Name:LIVINGSTON, NANCY J (FNP-C)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:J
Last Name:LIVINGSTON
Suffix:
Gender:
Credentials:FNP-C
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:LIVINGSTON
Other - Last Name:WELTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:121 N PETE ELLIS DR STE 102
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47408-4487
Mailing Address - Country:US
Mailing Address - Phone:866-434-3255
Mailing Address - Fax:
Practice Address - Street 1:121 N PETE ELLIS DR STE 102
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47408-4487
Practice Address - Country:US
Practice Address - Phone:866-434-3255
Practice Address - Fax:833-450-5430
Is Sole Proprietor?:No
Enumeration Date:2022-09-30
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71013110A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily