Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 29919 | WA |
NPI | 1003870361 |
---|---|
Provider Name | Sandra Liu |
First Address | Everett, WA 98206-5127 |
Second Address | Everett, WA 98201-4918 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2006 |
Last Update Date | 13/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1000139 | (05) | WA |
H85637 | (02) | WA |