Healthcare Provider Details

I. General information

NPI: 1780308932
Provider Name (Legal Business Name): NANCY J LIVINGSTON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NANCY LIVINGSTON WELTY

II. Dates (important events)

Enumeration Date: 09/30/2022
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 N PETE ELLIS DR STE 102
BLOOMINGTON IN
47408-4487
US

IV. Provider business mailing address

121 N PETE ELLIS DR STE 102
BLOOMINGTON IN
47408-4487
US

V. Phone/Fax

Practice location:
  • Phone: 866-434-3255
  • Fax: 833-450-5430
Mailing address:
  • Phone: 866-434-3255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71013110A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: