Individual provider Active NPI

Brandon M. Liu, ARNP, FA

  • Nurse Practitioner
  • Seattle, WA
National Provider Identifier
1639339708
Registry record updated Jul 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
AP60208496 Issued in WA
Practice address
611 Maynard Ave S
Seattle, WA 98104
Phone
(425) 283-8895
Fax
(877) 631-3356
NPI assigned
Jun 12, 2008
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 26, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X RN00151462 WA
Adult Health Nurse Practitioner 363LA2200X AP60208496 WA
Nurse Practitioner 363L00000X AP60208496 WA Primary

Addresses

Primary practice location

611 Maynard Ave S
Seattle, WA 98104

Mailing address

PO Box 14064
Seattle, WA 98114-0064
Phone (425) 283-8895

Other practice location 1

1101 Madison St Ste 1400
Seattle, WA 98104-4308
Phone (206) 386-6266

Other identifiers 1

IdentifierTypeStateIssuer
1639339708MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
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
I20110420000799 WA Practitioner - Nurse Practitioner 9931384740 Practice locations: Seattle, WA

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

601 S King St
Suite 303
Seattle, WA 98104-2922
Phone (425) 283-8895

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
AP60208496WAMDNurse Practitioner

Interoperability endpoints

  • Direct secure messaging: bliu1060539@wm.providencedirect.org

NPI Registry JSON

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

{
    "created_epoch": "1213228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721952000000",
    "number": "1639339708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 14064",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981140064",
            "telephone_number": "425-283-8895",
            "fax_number": "877-631-3356"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "611 MAYNARD AVE S",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "98104",
            "telephone_number": "425-283-8895",
            "fax_number": "877-631-3356"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1101 Madison St Ste 1400",
            "address_purpose": "LOCATION",
            "city": "Seattle",
            "state": "WA",
            "postal_code": "981044308",
            "country_code": "US",
            "telephone_number": "206-386-6266",
            "fax_number": "206-386-2844",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LIU",
        "first_name": "BRANDON",
        "middle_name": "M.",
        "credential": "ARNP, FA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-06-12",
        "last_updated": "2024-07-26",
        "certification_date": "2024-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "WA",
            "license": "RN00151462",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "WA",
            "license": "AP60208496",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WA",
            "license": "AP60208496",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1639339708",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Seattle, WA

Sources for this page

Verify at the official NPI Registry.