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General NPI Number Information
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NPI Number | 1710403118
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Entity Type | Organization
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Legal Business Name | LIV-ON FAMILY CARE CENTER, PA
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Dates
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Enumeration Date | 08/17/2017
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Last Update Date | 10/05/2021
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Provider Practice Location Address
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Address Line | 5 COUNTY ROAD B E STE 3
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City | SAINT PAUL
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State | MN
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Zip | 55117-1945
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Country | US
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Telephone | 651-207-8372
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Fax | 651-379-4727
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Provider Business Mailing Address
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Address Line | 5 COUNTY ROAD B E STE 3
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City | SAINT PAUL
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State | MN
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Zip | 55117-1945
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Country | US
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Telephone | 651-207-8372
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Fax | 651-379-4727
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | MRS. FLORENCE FON
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Credential | APRN-FNP-BC
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Telephone | 651-666-0915
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 2014035499
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License Number State | MN
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