Provider Demographics
NPI:1780087643
Name:LIU, JING (APRN)
Entity type:Individual
Prefix:
First Name:JING
Middle Name:
Last Name:LIU
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MRS
Other - First Name:JING
Other - Middle Name:
Other - Last Name:LIU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:5245 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-2503
Mailing Address - Country:US
Mailing Address - Phone:614-557-6075
Mailing Address - Fax:
Practice Address - Street 1:5245 E MAIN ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-2503
Practice Address - Country:US
Practice Address - Phone:614-557-6075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-06
Last Update Date:2016-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.17169-NP.363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health