Healthcare Provider Details

I. General information

NPI: 1427130178
Provider Name (Legal Business Name): JEANNETTE A. LIVELY RN, MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 01/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 COOLIDGE ST SUITE 2
GREENEVILLE TN
37743-4672
US

IV. Provider business mailing address

1021 COOLIDGE ST SUITE 2
GREENEVILLE TN
37743-4672
US

V. Phone/Fax

Practice location:
  • Phone: 423-636-2300
  • Fax: 423-636-0348
Mailing address:
  • Phone: 423-636-2300
  • Fax: 423-636-0348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberRN0000120048
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: