MEDICARE: COLLEEN ADRIS LIVINGSTONE NP

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
1	207RH0003X	Hematology & Oncology Physician	65316	DC
2	363L00000X	Nurse Practitioner	RN196643	MA

General Provider Information

NPI Number	:	1508802547
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COLLEEN ADRIS LIVINGSTONE NP

Provider Business Mailing Address
First Line	:	150 S. HUNTINGTON AVE
Second Line	:	(111) HO
City	:	JAMAICA PLAIN
State	:	MA
Zip	:	02130-4893
Country	:	US
Telephone Number	:	857-364-2471
Fax Number	:	857-364-4343

Provider Business Practice Location Address
First Line	:	150 S. HUNTINGTON AVE
Second Line	:	(111) HO
City	:	JAMAICA PLAIN
State	:	MA
Zip	:	02130-4893
Country	:	US
Telephone Number	:	857-364-2471
Fax Number	:	857-364-4343

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2006
Last Update Date	:	07/13/2012

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