Provider Demographics
NPI:1467787580
Name:LO, MAI KER (RN)
Entity Type:Individual
Prefix:
First Name:MAI
Middle Name:KER
Last Name:LO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 E 28TH ST
Mailing Address - Street 2:SUITE 170
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55406-2990
Mailing Address - Country:US
Mailing Address - Phone:612-872-1950
Mailing Address - Fax:
Practice Address - Street 1:2700 E 28TH ST
Practice Address - Street 2:SUITE 170
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55406-2990
Practice Address - Country:US
Practice Address - Phone:612-872-1950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-07
Last Update Date:2011-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN190747-4163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1902070584Medicaid