Active NPI
Nancy Liddy
- Adult Health Nurse Practitioner
- Minneapolis, MN
National Provider Identifier
1891716528
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Health Nurse Practitioner
- License
- R072865-4
- Practice address
- 525 Portland Ave
MC: 952
Minneapolis, MN 55415-1533 - Phone
- (612) 348-9840
- Fax
- (612) 596-7900
- NPI assigned
- Jul 21, 2006
- 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 |
|---|---|---|---|---|
| Adult Health Nurse Practitioner | 363LA2200X | R072865-4 | MN | Primary |
Addresses
Primary practice location
525 Portland Ave
MC: 952
Minneapolis, MN 55415-1533
Mailing address
525 Portland Ave
MC: 952
Minneapolis, MN 55415-1533
Phone (612) 348-9840
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7497229-00 | Medicaid | MN | |
| 715711042694 | Other | MN | PREFERRED ONE |
| 9G707LI | Other | MN | BLUE CROSS BLUE SHIELD |
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)
- Enrolled
- Credentials
- Certified Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R072865-4 | MN | MD | Adult Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hennepin County | Past | Accepting new patients | |
| Hennepin County | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Public Health or Welfare Agency
- Minneapolis, MN
- NPI 1619041845
-
- Psychiatry Physician
- Minneapolis, MN
- NPI 1780790345
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153440000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1365984000000",
"number": "1891716528",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "525 PORTLAND AVE",
"address_2": "MC: 952",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554151533",
"telephone_number": "612-348-9840",
"fax_number": "612-596-7900"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "525 PORTLAND AVE",
"address_2": "MC: 952",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554151533",
"telephone_number": "612-348-9840",
"fax_number": "612-596-7900"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LIDDY",
"first_name": "NANCY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-21",
"last_updated": "2013-04-15",
"status": "A"
},
"taxonomies": [
{
"code": "363LA2200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Adult Health",
"state": "MN",
"license": "R072865-4",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7497229-00",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREFERRED ONE",
"identifier": "715711042694",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "9G707LI",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Minneapolis, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.