Active NPI
Mai Tia Ly, REGISTERED NURSE
- Registered Nurse
- Roseville, MN
National Provider Identifier
1265731319
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- R194859-8
- Practice address
- 2499 Rice St
Suite 132
Roseville, MN 55113-3724 - Phone
- (651) 494-9058
- Fax
- (651) 494-6680
- NPI assigned
- Mar 15, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | R194859-8 | MN | Primary |
Addresses
Primary practice location
2499 Rice St
Suite 132
Roseville, MN 55113-3724
Mailing address
2499 Rice St
Suite 132
Roseville, MN 55113-3724
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R194859-8 | MN | MD | Registered Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Big Brothers Home Health Care, LLC | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Home Health Agency
- Roseville, MN
- NPI 1104125251
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1300147200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1554163200000",
"number": "1265731319",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2499 RICE ST",
"address_2": "SUITE 132",
"city": "ROSEVILLE",
"state": "MN",
"postal_code": "551133724"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2499 RICE ST",
"address_2": "SUITE 132",
"city": "ROSEVILLE",
"state": "MN",
"postal_code": "551133724",
"telephone_number": "651-494-9058",
"fax_number": "651-494-6680"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LY",
"first_name": "MAI",
"middle_name": "TIA",
"credential": "REGISTERED NURSE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-03-15",
"last_updated": "2019-04-02",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "MN",
"license": "R194859-8",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Roseville, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.