Healthcare Provider Details

I. General information

NPI: 1184080442
Provider Name (Legal Business Name): WAYNA HEIDI LIU P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/01/2016
Last Update Date: 04/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2950 S ALMA SCHOOL RD STE 1
CHANDLER AZ
85286-8120
US

IV. Provider business mailing address

4225 E MCDOWELL RD #3021
PHOENIX AZ
85008-7475
US

V. Phone/Fax

Practice location:
  • Phone: 480-827-5690
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: