Healthcare Provider Details

I. General information

NPI: 1205583705
Provider Name (Legal Business Name): XIAOSONG LIU CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2022
Last Update Date: 09/12/2023
Certification Date: 09/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 OLENTANGY RIVER RD
COLUMBUS OH
43214-3908
US

IV. Provider business mailing address

5151 REED RD STE 225C
COLUMBUS OH
43220-2553
US

V. Phone/Fax

Practice location:
  • Phone: 614-566-4919
  • Fax:
Mailing address:
  • Phone: 614-884-0641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0020680
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number301135
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: