Provider Demographics
NPI:1942273164
Name:REN, LIANA (CRNA)
Entity type:Individual
Prefix:MS
First Name:LIANA
Middle Name:
Last Name:REN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5701 NE BOTHELL WAY STE 4
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:WA
Mailing Address - Zip Code:98028-9400
Mailing Address - Country:US
Mailing Address - Phone:425-835-2363
Mailing Address - Fax:425-368-7634
Practice Address - Street 1:5701 NE BOTHELL WAY STE 4
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:WA
Practice Address - Zip Code:98028-9400
Practice Address - Country:US
Practice Address - Phone:425-835-2363
Practice Address - Fax:425-368-7634
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60402981367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1942273164Medicaid
WA1942273164Medicaid
PA087496FEVMedicare ID - Type Unspecified