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Individual
MS. MARY MICHELLE LIVELY
Active
Individual
MS. MARY MICHELLE LIVELY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
AP122051
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
338206102
—
TX
05
—
338206103
—
TX
01
—
8543NH
BCBS TX
TX
Enumeration date
11/27/2012
Last updated
09/20/2016
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