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NPI Code Detail

MEDICARE: MRS. TAMELLA PAIGE LIVENGOOD MSN, FNP

MEDICARE: MRS. TAMELLA PAIGE LIVENGOOD MSN, FNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner4704197389MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1407038151
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. TAMELLA PAIGE LIVENGOOD MSN, FNP
Provider Business Mailing Address
First Line : 4977 SKYVIEW CT
Second Line :
City : TRAVERSE CITY
State : MI
Zip : 49684-6941
Country : US
Telephone Number : 231-486-5516
Fax Number : 231-421-1439
Provider Business Practice Location Address
First Line : 10223 E CHERRY BEND RD
Second Line :
City : TRAVERSE CITY
State : MI
Zip : 49684-7304
Country : US
Telephone Number : 231-929-7933
Fax Number : 231-929-7934
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/04/2007
Last Update Date : 08/01/2024

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