Healthcare Provider Details

I. General information

NPI: 1891102208
Provider Name (Legal Business Name): HANNAH LIU PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HANNAH DOLAN

II. Dates (important events)

Enumeration Date: 07/17/2014
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4302 GATEWAY DR
GENESEO NY
14454-9449
US

IV. Provider business mailing address

100 KINGS HWY S
ROCHESTER NY
14617-5504
US

V. Phone/Fax

Practice location:
  • Phone: 585-243-5990
  • Fax: 585-243-3256
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number017580
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: