Provider Demographics
NPI:1154702702
Name:LIU, YONGBAO (APRN)
Entity type:Individual
Prefix:
First Name:YONGBAO
Middle Name:
Last Name:LIU
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:35 TALCOTTVILLE ROAD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066
Mailing Address - Country:US
Mailing Address - Phone:718-353-0555
Mailing Address - Fax:718-353-0566
Practice Address - Street 1:35 TALCOTTVILLE ROAD
Practice Address - Street 2:SUITE 6
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066
Practice Address - Country:US
Practice Address - Phone:860-870-6385
Practice Address - Fax:860-870-0625
Is Sole Proprietor?:No
Enumeration Date:2015-06-09
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY339567363LF0000X
CT9920363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily