Healthcare Provider Details

I. General information

NPI: 1053741728
Provider Name (Legal Business Name): EMILY LIVENGOOD ND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2013
Last Update Date: 07/29/2021
Certification Date: 07/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 SW SHEVLIN HIXON DR STE 101
BEND OR
97702-3232
US

IV. Provider business mailing address

PO BOX 1525
BEND OR
97709-1525
US

V. Phone/Fax

Practice location:
  • Phone: 541-907-1729
  • Fax:
Mailing address:
  • Phone: 206-948-5016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberNT60413628
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number4087
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: