Provider Demographics
NPI:1053823732
Name:LIU, CHYNA (BSN, RN)
Entity Type:Individual
Prefix:
First Name:CHYNA
Middle Name:
Last Name:LIU
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4663 N 109TH ST
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53225-4405
Mailing Address - Country:US
Mailing Address - Phone:414-526-3700
Mailing Address - Fax:
Practice Address - Street 1:4663 N 109TH ST
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53225-4405
Practice Address - Country:US
Practice Address - Phone:414-526-3700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-02
Last Update Date:2020-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI189898163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health