=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023310547
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LYNETTE LIVINGSTON RN,MSN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/04/2010
-----------------------------------------------------
Last Update Date | 03/03/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 205 LEXINGTON AVE
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10016-6022
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-732-7171
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11818 221ST ST
-----------------------------------------------------
City | CAMBRIA HEIGHTS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11411-2013
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-210-8960
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WA2000X
-----------------------------------------------------
Taxonomy Name | Administrator Registered Nurse
-----------------------------------------------------
License Number | 380598-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 163WG0600X
-----------------------------------------------------
Taxonomy Name | Gerontology Registered Nurse
-----------------------------------------------------
License Number | 380598-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 163WM0705X
-----------------------------------------------------
Taxonomy Name | Medical-Surgical Registered Nurse
-----------------------------------------------------
License Number | 380598-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 163WP2201X
-----------------------------------------------------
Taxonomy Name | Ambulatory Care Registered Nurse
-----------------------------------------------------
License Number | 380598-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 302F00000X
-----------------------------------------------------
Taxonomy Name | Exclusive Provider Organization
-----------------------------------------------------
License Number | 380598-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------