Provider Demographics
NPI:1679578371
Name:LIU, NIANSEN (MD)
Entity Type:Individual
Prefix:DR
First Name:NIANSEN
Middle Name:
Last Name:LIU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3555 KEITH ST NW
Mailing Address - Street 2:STE 102
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-4375
Mailing Address - Country:US
Mailing Address - Phone:423-728-2282
Mailing Address - Fax:423-728-2234
Practice Address - Street 1:3555 KEITH ST NW
Practice Address - Street 2:STE 102
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-4375
Practice Address - Country:US
Practice Address - Phone:423-728-2282
Practice Address - Fax:423-728-2234
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-17
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN364062084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN38783611Medicaid
4175788OtherBCBS
TN38783611Medicaid
TNH70417Medicare UPIN