Healthcare Provider Details

I. General information

NPI: 1962659201
Provider Name (Legal Business Name): AMY LIVERMAN WILLIFORD NNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2008
Last Update Date: 06/15/2023
Certification Date: 06/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 STATONSBURG ROAD
GREENVILLE NC
27834
US

IV. Provider business mailing address

207 HOFLER AVE
WINDSOR NC
27983-1617
US

V. Phone/Fax

Practice location:
  • Phone: 252-847-4113
  • Fax: 252-847-9946
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number178440
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: