Individual provider Active NPI

Jennifer Shaw-Chin Liu, FNP

  • Family Nurse Practitioner
  • Novato, CA
National Provider Identifier
1114148293
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
16783 Issued in CA
Practice address
165 Rowland Way
Suite 215
Novato, CA 94945-5038
Phone
(415) 897-5171
Fax
(415) 892-1611
NPI assigned
May 2, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 16783 CA Primary

Addresses

Primary practice location

165 Rowland Way
Suite 215
Novato, CA 94945-5038

Mailing address

165 Rowland Way
Suite 215
Novato, CA 94945-5038
Phone (415) 897-5171

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090716000506 CA Practitioner - Nurse Practitioner 2365594611 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
16783CAMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
City & County of San Francisco Current Accepting new patients
City & County of San Francisco CurrentSince Jun 1, 2011 Accepting new patients
City and County of San Francisco CurrentSince Jun 1, 2011 Accepting new patients

Locations

1001 Potrero Ave
San Francisco, CA 94110
Phone (415) 206-2305

1001 Potrero Ave
Bldg 20
San Francisco, CA 94110
Phone (415) 206-8524

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1114148293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "165 ROWLAND WAY",
            "address_2": "SUITE 215",
            "city": "NOVATO",
            "state": "CA",
            "postal_code": "949455038",
            "telephone_number": "415-897-5171",
            "fax_number": "415-892-1611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "165 ROWLAND WAY",
            "address_2": "SUITE 215",
            "city": "NOVATO",
            "state": "CA",
            "postal_code": "949455038",
            "telephone_number": "415-897-5171",
            "fax_number": "415-892-1611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIU",
        "first_name": "JENNIFER",
        "middle_name": "SHAW-CHIN",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-02",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "16783",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Novato, CA

Sources for this page

Verify at the official NPI Registry.