Healthcare Provider Details

I. General information

NPI: 1104117530
Provider Name (Legal Business Name): CAROLE ANN LIU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2011
Last Update Date: 04/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6079 MASON CT
MAGALIA CA
95954-9678
US

IV. Provider business mailing address

6079 MASON CT
MAGALIA CA
95954-9678
US

V. Phone/Fax

Practice location:
  • Phone: 530-520-7948
  • Fax: 530-873-6179
Mailing address:
  • Phone: 530-520-7948
  • Fax: 530-873-6179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1600X
TaxonomyContinuing Education/Staff Development Registered Nurse
License Number659398
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WC3500X
TaxonomyCardiac Rehabilitation Registered Nurse
License Number659398
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number659398
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number659398
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code163WI0600X
TaxonomyInfection Control Registered Nurse
License Number659398
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code163WR0400X
TaxonomyRehabilitation Registered Nurse
License Number659398
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number659398
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: