Provider Demographics
NPI:1356811475
Name:BACA, EUGENA LIU PAOLIEN (DNP)
Entity type:Individual
Prefix:
First Name:EUGENA
Middle Name:LIU PAOLIEN
Last Name:BACA
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:EUGENA
Other - Middle Name:LIU PAOLIEN
Other - Last Name:BERGVALL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DNP
Mailing Address - Street 1:4601 N CHELSEA LN
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-3711
Mailing Address - Country:US
Mailing Address - Phone:801-897-6784
Mailing Address - Fax:
Practice Address - Street 1:9000 ROCKVILLE PIKE BLDG 10
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20892-0001
Practice Address - Country:US
Practice Address - Phone:301-451-1250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-01
Last Update Date:2018-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR219923363LA2200X
MDC500138364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health