Healthcare Provider Details

I. General information

NPI: 1629129770
Provider Name (Legal Business Name): LINDA LIU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 WINTER ST SUITE 3800
WALTHAM MA
02451-1424
US

IV. Provider business mailing address

27 HERRICK RD #3
NEWTON MA
02459-2238
US

V. Phone/Fax

Practice location:
  • Phone: 781-472-8614
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number215886
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: