Healthcare Provider Details

I. General information

NPI: 1922115039
Provider Name (Legal Business Name): NANCY ELLEN LIEVING CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 COUNTY HOUSE RD
SEWELL NJ
08080-2525
US

IV. Provider business mailing address

108 AUSTIN CT
WOODBURY NJ
08096-5113
US

V. Phone/Fax

Practice location:
  • Phone: 856-401-7665
  • Fax:
Mailing address:
  • Phone: 856-848-1893
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number26NJ00096400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: