Healthcare Provider Details

I. General information

NPI: 1053690701
Provider Name (Legal Business Name): VIVIAN CHAO LIU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VIVIAN CHAO

II. Dates (important events)

Enumeration Date: 08/12/2011
Last Update Date: 08/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

517 W GRACE ST
RICHMOND VA
23220-4911
US

IV. Provider business mailing address

517 W GRACE ST
RICHMOND VA
23220-4911
US

V. Phone/Fax

Practice location:
  • Phone: 804-783-2505
  • Fax: 804-783-2514
Mailing address:
  • Phone: 804-783-2505
  • Fax: 804-783-2514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024169479
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: