Individual provider Active NPI

Rose Solly, NURSE PRACTITIONER

  • Family Nurse Practitioner
  • Minneapolis, MN
National Provider Identifier
1396288577
Registry record updated Aug 30, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
6735 Issued in MN
Practice address
3805 Washington Ave N
Minneapolis, MN 55412-2141
Phone
(612) 887-6282
Fax
(612) 437-4992
NPI assigned
Nov 21, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X R 174081-9 MN
Family Nurse Practitioner 363LF0000X 6735 MN Primary

Addresses

Primary practice location

3805 Washington Ave N
Minneapolis, MN 55412-2141

Mailing address

3805 Washington Ave N
Minneapolis, MN 55412-2141
Phone (128) 876-2826

Other practice location 1

680 Stewart Ave
Saint Paul, MN 55102-4117
Phone (651) 292-2499

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
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
I20230124002824 MN Practitioner - Nurse Practitioner 8426429705 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Lakes Area Health Center PLLCGroup PAC ID 9234179664, 2 clinicians

Practice addresses (Care Compare)

1440 Duckwood Dr
Suite 200
Eagan, MN 55122-1451
Phone (651) 203-4673

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R 174081-9MNMDRegistered Nurse
6735MNMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Lakes Area Health Center, PLLC CurrentSince Jun 16, 2024 Accepting new patients

Locations

1440 Duckwood Dr
Ste 200
Saint Paul, MN 55122
Phone (651) 203-4673

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.

NPI Registry JSON

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

{
    "created_epoch": "1479686400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661817600000",
    "number": "1396288577",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3805 WASHINGTON AVE N",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554122141",
            "telephone_number": "128-876-2826",
            "fax_number": "612-437-4992"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3805 WASHINGTON AVE N",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554122141",
            "telephone_number": "612-887-6282",
            "fax_number": "612-437-4992"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "680 Stewart Ave",
            "address_purpose": "LOCATION",
            "city": "Saint Paul",
            "state": "MN",
            "postal_code": "551024117",
            "country_code": "US",
            "telephone_number": "651-292-2499",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SOLLY",
        "first_name": "ROSE",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-11-21",
        "last_updated": "2022-08-30",
        "certification_date": "2022-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MN",
            "license": "R 174081-9",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MN",
            "license": "6735",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.