Healthcare Provider Details

I. General information

NPI: 1053273896
Provider Name (Legal Business Name): MI AYE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4703 N 66TH ST APT 45
OMAHA NE
68104-1957
US

IV. Provider business mailing address

3133 N 47TH AVE
OMAHA NE
68104-3723
US

V. Phone/Fax

Practice location:
  • Phone: 531-272-5462
  • Fax:
Mailing address:
  • Phone: 531-272-5462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: