Healthcare Provider Details

I. General information

NPI: 1821485749
Provider Name (Legal Business Name): JENNIFER LIU RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2015
Last Update Date: 04/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 EXEMPLA CIR
LAFAYETTE CO
80026-3370
US

IV. Provider business mailing address

7193 E 131ST PL
THORNTON CO
80602-4675
US

V. Phone/Fax

Practice location:
  • Phone: 303-338-4545
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number166500
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code163WX0003X
TaxonomyInpatient Obstetric Registered Nurse
License Number166500
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: