Healthcare Provider Details

I. General information

NPI: 1063929248
Provider Name (Legal Business Name): MELISSA MICHELLE LIVINGSTON FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2018
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 S TRIVIZ DR STE F
LAS CRUCES NM
88001-0601
US

IV. Provider business mailing address

4886 CALLE BELLA AVE
LAS CRUCES NM
88012-7055
US

V. Phone/Fax

Practice location:
  • Phone: 575-556-1849
  • Fax: 575-532-2030
Mailing address:
  • Phone: 575-491-4764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP-03472
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: