=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912206897
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NANCY TURNBULL LIVADA PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/18/2011
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 41 MALL RD
-----------------------------------------------------
City | BURLINGTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01805-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-744-8584
-----------------------------------------------------
Fax | 781-744-1052
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | LAHEY HOSPITAL & MEDICAL CENTER 41 MALL ROAD
-----------------------------------------------------
City | BURLINGTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01805-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-744-8584
-----------------------------------------------------
Fax | 781-744-1052
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | PA4828
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------