Provider Demographics
NPI:1093552465
Name:LIEU, JENNIFER MAY (NP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MAY
Last Name:LIEU
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 276950
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-6950
Mailing Address - Country:US
Mailing Address - Phone:415-688-0160
Mailing Address - Fax:415-558-7036
Practice Address - Street 1:2324 SACRAMENTO ST STE 111
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-2383
Practice Address - Country:US
Practice Address - Phone:415-668-0160
Practice Address - Fax:415-558-7036
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-11
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95030801363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty