Provider Demographics
NPI:1114253457
Name:LIU, EDWARD (ANP)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:LIU
Suffix:
Gender:M
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3311 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94550-7007
Mailing Address - Country:US
Mailing Address - Phone:925-462-1755
Mailing Address - Fax:925-201-6295
Practice Address - Street 1:3311 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-7007
Practice Address - Country:US
Practice Address - Phone:925-462-1755
Practice Address - Fax:925-201-6295
Is Sole Proprietor?:No
Enumeration Date:2009-10-21
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60118146163W00000X
CARN709195163W00000X
CAPHN74857163WC1500X
CANP19114363LA2200X
WAAP60118946363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9662180Medicaid
G8890350OtherMEDICARE PTAN