Provider Demographics
NPI:1053741728
Name:LIVENGOOD, EMILY (ND)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:LIVENGOOD
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1525
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97709-1525
Mailing Address - Country:US
Mailing Address - Phone:206-948-5016
Mailing Address - Fax:
Practice Address - Street 1:151 SW SHEVLIN HIXON DR STE 101
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3232
Practice Address - Country:US
Practice Address - Phone:541-907-1729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-18
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT60413628207Q00000X
OR4087175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine