Individual
BRENDA LOU LIVENGOOD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6216 W GLENDALE AVE, GLENDALE, AZ 85301-2308
(623) 435-6230
(623) 435-6270
Mailing address
10955 N 79TH AVE LOT 99, PEORIA, AZ 85345-5974
(623) 435-6203
(623) 435-6270
Taxonomy
Speciality
Code
Description
License number
State
163WS0200X
School Registered Nurse
Primary
089041
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
920076
—
AZ
Enumeration date
03/01/2007
Last updated
07/09/2007
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