Individual
DEMETRIUS DELORES LIVINGSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
1421 BLUFF RD, COLUMBIA, SC 29201-4809
(803) 733-5855
Mailing address
1421 BLUFF RD, COLUMBIA, SC 29201-4809
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
48915
SC
Other
Enumeration date
07/17/2019
Last updated
07/17/2019
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