Provider Demographics
NPI:1104117530
Name:LIU, CAROLE ANN
Entity type:Individual
Prefix:
First Name:CAROLE
Middle Name:ANN
Last Name:LIU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6079 MASON CT
Mailing Address - Street 2:
Mailing Address - City:MAGALIA
Mailing Address - State:CA
Mailing Address - Zip Code:95954-9678
Mailing Address - Country:US
Mailing Address - Phone:530-520-7948
Mailing Address - Fax:530-873-6179
Practice Address - Street 1:6079 MASON CT
Practice Address - Street 2:
Practice Address - City:MAGALIA
Practice Address - State:CA
Practice Address - Zip Code:95954-9678
Practice Address - Country:US
Practice Address - Phone:530-520-7948
Practice Address - Fax:530-873-6179
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-19
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA659398163WC1600X, 163WC3500X, 163WD0400X, 163WG0000X, 163WI0600X, 163WR0400X, 163WW0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development
No163WC3500XNursing Service ProvidersRegistered NurseCardiac Rehabilitation
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
No163WI0600XNursing Service ProvidersRegistered NurseInfection Control
No163WR0400XNursing Service ProvidersRegistered NurseRehabilitation
No163WW0000XNursing Service ProvidersRegistered NurseWound Care