Healthcare Provider Details

I. General information

NPI: 1578509295
Provider Name (Legal Business Name): JIAN HUA LIU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JIAN HUA LIU NP

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 HARRISON AVE
BOSTON MA
02118-2393
US

IV. Provider business mailing address

47 MOUNT VERNON ST
BRIGHTON MA
02135-3212
US

V. Phone/Fax

Practice location:
  • Phone: 617-638-8906
  • Fax:
Mailing address:
  • Phone: 617-987-0051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number207584
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: