Provider Demographics
NPI:1194947077
Name:LIU, GLORIA (APRN)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:
Last Name:LIU
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 PARSONAGE RD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08837-2429
Mailing Address - Country:US
Mailing Address - Phone:732-494-6226
Mailing Address - Fax:732-494-8762
Practice Address - Street 1:10 PARSONAGE RD
Practice Address - Street 2:SUITE 500
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08837-2429
Practice Address - Country:US
Practice Address - Phone:732-494-6226
Practice Address - Fax:732-494-8762
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00023100363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health