Healthcare Provider Details

I. General information

NPI: 1972386514
Provider Name (Legal Business Name): ELIZABETH XI LIU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2023
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7105 LAKEVIEW PKWY STE 100
ROWLETT TX
75088-4202
US

IV. Provider business mailing address

11480 AUDELIA RD APT 138
DALLAS TX
75243-7316
US

V. Phone/Fax

Practice location:
  • Phone: 972-475-5300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA19637
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: