Individual
TRACEY LIVERMORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
3250 N MONROE ST, MONROE, MI 48162-9297
(734) 547-7009
Mailing address
3250 N MONROE ST, MONROE, MI 48162-9297
(734) 547-5009
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703107899
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NONE
NONE
—
Enumeration date
01/20/2023
Last updated
01/20/2023
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