Individual
PEGGY YVONNE LIVELY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
1120 GLENNS BAY RD, SURFSIDE BEACH, SC 29575-4757
(843) 215-5492
Mailing address
1916 SHELL CT, SURFSIDE BEACH, SC 29575-4630
(954) 895-0222
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
3938
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NP1563
—
SC
Enumeration date
03/29/2007
Last updated
09/12/2013
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