# LIVINGSTON MED SPA PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** LIV MED SPA
- **Organization subpart:** No

## Provider details

- **NPI number:** 1033805635
- **Authorized official:** GRETCHEN WISE NP (OWNER)
- **Authorized official phone:** (406) 224-3036

## Contact information

- **Practice address:** 115 HIGH GROUND AVE, LIVINGSTON, MT 59047-3906
- **Practice address phone:** (406) 224-3036
- **Mailing address:** 115 HIGH GROUND AVE, LIVINGSTON, MT 59047-3906
- **Mailing address phone:** (406) 224-3036

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | — | NULL | Yes |
| 363L00000X | Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 04/17/2023
- **Last updated:** 04/17/2023