Provider Demographics
NPI:1124126826
Name:LIU, JIN LAN (RN)
Entity type:Individual
Prefix:
First Name:JIN LAN
Middle Name:
Last Name:LIU
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1508 AVENUE U
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-3808
Mailing Address - Country:US
Mailing Address - Phone:718-376-3383
Mailing Address - Fax:718-376-3385
Practice Address - Street 1:1508 AVENUE U
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-3808
Practice Address - Country:US
Practice Address - Phone:718-376-3383
Practice Address - Fax:718-376-3385
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY495983-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY495983-1OtherNY LICENSE NUMBER