Provider Demographics
NPI:1548999063
Name:LIVINGSTON, STACI (NP)
Entity type:Individual
Prefix:
First Name:STACI
Middle Name:
Last Name:LIVINGSTON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N3507 COUNTRY RD M
Mailing Address - Street 2:NONE
Mailing Address - City:WEST SALEM
Mailing Address - State:WI
Mailing Address - Zip Code:54669
Mailing Address - Country:US
Mailing Address - Phone:262-623-0304
Mailing Address - Fax:
Practice Address - Street 1:N3507 COUNTRY RD M
Practice Address - Street 2:NONE
Practice Address - City:WEST SALEM
Practice Address - State:WI
Practice Address - Zip Code:54669
Practice Address - Country:US
Practice Address - Phone:262-623-0304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-09
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE116001363LP0808X
WI11972-33363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health