Provider Demographics
NPI:1215995899
Name:LIU, JOANN (NP)
Entity type:Individual
Prefix:
First Name:JOANN
Middle Name:
Last Name:LIU
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JUAN
Other - Middle Name:
Other - Last Name:LIU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:ELM AND CARLTON ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14263-0001
Mailing Address - Country:US
Mailing Address - Phone:716-845-2300
Mailing Address - Fax:716-845-3272
Practice Address - Street 1:ELM AND CARLTON ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14263-0001
Practice Address - Country:US
Practice Address - Phone:716-845-2300
Practice Address - Fax:716-845-3272
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2013-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY332359363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY050711000003OtherFIDELIS CARE #
NY9512344OtherIHA #
NY000560402010OtherHEALTH NOW BCBS #
NY00030600602OtherUNIVERA #
NYP00254615OtherMEDICARE RAILROAD #
NY157602BFOtherPREFERRED CARE #
NY00030600602OtherUNIVERA #
NYP00254615OtherMEDICARE RAILROAD #