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General NPI Number Information
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NPI Number | 1467985341
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Entity Type | Individual
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Provider Name | MARIE NICHOLE LIVESEY
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Gender | Female
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Dates
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Enumeration Date | 04/06/2017
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Last Update Date | 08/13/2025
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Provider Practice Location Address
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Address Line | 3700 FETTLER PARK DR
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City | DUMFRIES
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State | VA
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Zip | 22025-2050
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Country | US
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Telephone | 703-441-7500
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Fax |
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Provider Business Mailing Address
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Address Line | 100 BREWSTER BLVD NAVAL HOSPITAL CAMP LEJEUNE ATTN: GME
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City | CAMP LEJEUNE
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State | NC
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Zip | 28547-2575
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0102208602
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 01081198A
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License Number State | IN
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