Healthcare Provider Details

I. General information

NPI: 1962783548
Provider Name (Legal Business Name): AMY LOU LIU ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2011
Last Update Date: 09/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1151 DENNY WAY
SEATTLE WA
98109-5326
US

IV. Provider business mailing address

9708 LINDEN AVE N
SEATTLE WA
98103-3237
US

V. Phone/Fax

Practice location:
  • Phone: 206-682-7418
  • Fax: 206-623-0884
Mailing address:
  • Phone: 847-508-9259
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP60238999
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: