Healthcare Provider Details

I. General information

NPI: 1861552143
Provider Name (Legal Business Name): FLORENCE M LIVELY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2006
Last Update Date: 11/18/2021
Certification Date: 11/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 KEDDIE ST
FALLON NV
89406-2820
US

IV. Provider business mailing address

727 FAIRVIEW DR STE A
CARSON CITY NV
89701-5493
US

V. Phone/Fax

Practice location:
  • Phone: 775-423-7141
  • Fax: 775-423-4020
Mailing address:
  • Phone: 775-684-5000
  • Fax: 775-681-1811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number19995
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN19995
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: