Provider Demographics
NPI:1194460717
Name:LIU, RICARDA LENG (MSN AGNP-C)
Entity Type:Individual
Prefix:
First Name:RICARDA
Middle Name:LENG
Last Name:LIU
Suffix:
Gender:F
Credentials:MSN AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1847 84TH ST APT 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-2986
Mailing Address - Country:US
Mailing Address - Phone:917-968-0298
Mailing Address - Fax:
Practice Address - Street 1:222 E 41ST ST FL 21
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-6739
Practice Address - Country:US
Practice Address - Phone:212-263-7951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-28
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF310421363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health