Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 95001977 | CA |
NPI | 1003214503 |
---|---|
Provider Name | Miss Macy Lieu |
First Address | Danville, CA 94526-4022 |
Second Address | Danville, CA 94526-4022 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2014 |
Last Update Date | 07/01/2020 |