Individual
ASHTYN LIVERMORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
12817 PARKVIEW PLAZA DR, FORT WAYNE, IN 46845-1741
(269) 275-1410
Mailing address
12817 PARKVIEW PLAZA DR, FORT WAYNE, IN 46845-1741
(269) 275-1410
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601013902
MI
Other
Enumeration date
07/15/2026
Last updated
07/15/2026
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