Provider Demographics
NPI:1811124506
Name:LIU, JEANNE G (MAOM)
Entity type:Individual
Prefix:
First Name:JEANNE
Middle Name:G
Last Name:LIU
Suffix:
Gender:F
Credentials:MAOM
Other - Prefix:
Other - First Name:GUIZHEN
Other - Middle Name:
Other - Last Name:LIU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:14 MICA LN
Mailing Address - Street 2:SUITE 10
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-1773
Mailing Address - Country:US
Mailing Address - Phone:781-235-6638
Mailing Address - Fax:
Practice Address - Street 1:14 MICA LN
Practice Address - Street 2:SUITE 10
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-1773
Practice Address - Country:US
Practice Address - Phone:781-235-6638
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-19
Last Update Date:2009-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA238267171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist