Healthcare Provider Details

I. General information

NPI: 1609220235
Provider Name (Legal Business Name): AMBER LIVINGSTON DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2016
Last Update Date: 09/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12333 NE 130TH LN STE TAN 320
KIRKLAND WA
98034-7467
US

IV. Provider business mailing address

PO BOX 34738
SEATTLE WA
98124-1738
US

V. Phone/Fax

Practice location:
  • Phone: 425-899-0555
  • Fax: 425-899-9458
Mailing address:
  • Phone: 425-899-1600
  • Fax: 425-899-1659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP60865817
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberRN60232815
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number201141451RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: