Provider Demographics
NPI:1750899191
Name:LIVENGOOD, CHRISTIE M (CRNP)
Entity type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:M
Last Name:LIVENGOOD
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:104 W CREEK RUN LOOP
Mailing Address - Street 2:
Mailing Address - City:FORT ASHBY
Mailing Address - State:WV
Mailing Address - Zip Code:26719-5002
Mailing Address - Country:US
Mailing Address - Phone:240-727-7740
Mailing Address - Fax:301-729-0180
Practice Address - Street 1:12301 AMHERST AVE NE
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-8123
Practice Address - Country:US
Practice Address - Phone:240-727-7740
Practice Address - Fax:240-512-8564
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-19
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDAC002277363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner