Provider Demographics
NPI:1487603106
Name:LIVINGSTON, BRYNNE A (PA-C)
Entity type:Individual
Prefix:
First Name:BRYNNE
Middle Name:A
Last Name:LIVINGSTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:BRYNNE
Other - Middle Name:A
Other - Last Name:SCHOENOFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13640 N PLAZA DEL RIO BLVD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4846
Mailing Address - Country:US
Mailing Address - Phone:623-876-3800
Mailing Address - Fax:623-583-5301
Practice Address - Street 1:14420 W MEEKER BLVD
Practice Address - Street 2:STE 104
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375-5286
Practice Address - Country:US
Practice Address - Phone:623-583-5300
Practice Address - Fax:623-583-5301
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3312363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ107216Medicare PIN
AZQ59909Medicare UPIN
AZZ107215Medicare PIN
AZP00365382Medicare PIN