Healthcare Provider Details

I. General information

NPI: 1942273164
Provider Name (Legal Business Name): LIANA REN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 10/25/2021
Certification Date: 10/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5701 NE BOTHELL WAY STE 4
KENMORE WA
98028-9400
US

IV. Provider business mailing address

5701 NE BOTHELL WAY STE 4
KENMORE WA
98028-9400
US

V. Phone/Fax

Practice location:
  • Phone: 425-835-2363
  • Fax: 425-368-7634
Mailing address:
  • Phone: 425-835-2363
  • Fax: 425-368-7634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP60402981
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: