Provider Demographics
NPI:1700165636
Name:LIOU, BORRU MING (APRN)
Entity Type:Individual
Prefix:
First Name:BORRU
Middle Name:MING
Last Name:LIOU
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:BELLA
Other - Middle Name:MING
Other - Last Name:LIOU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN
Mailing Address - Street 1:3015 WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40211-1969
Mailing Address - Country:US
Mailing Address - Phone:502-774-4401
Mailing Address - Fax:502-772-8983
Practice Address - Street 1:3015 WILSON AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40211-1969
Practice Address - Country:US
Practice Address - Phone:502-774-4401
Practice Address - Fax:502-772-8983
Is Sole Proprietor?:No
Enumeration Date:2011-08-09
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28190872A163W00000X
KY1109012163W00000X
IN71003947A363LF0000X
KY3006986363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK098507OtherMEDICARE
KY7100256740Medicaid