Healthcare Provider Details

I. General information

NPI: 1265475396
Provider Name (Legal Business Name): MING CHI MAYE CHAN RPA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 05/26/2023
Certification Date: 05/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 THOMPSON ST.
ST. PAUL MN
55102
US

IV. Provider business mailing address

166 4TH ST. E. STE. 100
ST. PAUL MN
55101
US

V. Phone/Fax

Practice location:
  • Phone: 651-292-2000
  • Fax:
Mailing address:
  • Phone: 651-292-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1761
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number13078
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: