Healthcare Provider Details

I. General information

NPI: 1679118434
Provider Name (Legal Business Name): HUANYI LIU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2019
Last Update Date: 02/01/2022
Certification Date: 02/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14910 PACIFIC AVE S
TACOMA WA
98444-4657
US

IV. Provider business mailing address

14910 PACIFIC AVE S
TACOMA WA
98444-4657
US

V. Phone/Fax

Practice location:
  • Phone: 253-433-3879
  • Fax:
Mailing address:
  • Phone: 253-433-3879
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP61204737
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: