Healthcare Provider Details

I. General information

NPI: 1962574814
Provider Name (Legal Business Name): GLORIA ANN LIU NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4785 N. FIRST STREET, KAISER PERMANENTE
FRESNO CA
93726
US

IV. Provider business mailing address

4785 N 1ST ST
FRESNO CA
93726-0513
US

V. Phone/Fax

Practice location:
  • Phone: 559-448-4745
  • Fax:
Mailing address:
  • Phone: 559-448-4745
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number253457
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: