Provider Demographics
NPI:1881348324
Name:LIVINGSTON, LAURA KOFF (NP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:KOFF
Last Name:LIVINGSTON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8111 REYNARD RD
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27516-9278
Mailing Address - Country:US
Mailing Address - Phone:910-685-5735
Mailing Address - Fax:
Practice Address - Street 1:4551 NEW BERN AVE STE 160
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-1552
Practice Address - Country:US
Practice Address - Phone:919-556-1008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-03
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5015729363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5015729OtherNCBON