Basic Information
| Provider Information | |||||||||
| NPI: | 1760152912 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LOUIS | ||||||||
| FirstName: | MAXIANA | ||||||||
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| Credential: | NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 884 WASHINGTON ST | ||||||||
| Address2: | |||||||||
| City: | BALDWIN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115104635 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3472176772 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1752 FRANCIS LEWIS BLVD | ||||||||
| Address2: | |||||||||
| City: | WHITESTONE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113573247 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187469494 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/19/2021 | ||||||||
| LastUpdateDate: | 01/19/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/19/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP2300X | 310381 | NY | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care | 363LP2300X | F310381-01 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care | 363LP2300X | F310381-01 | NJ | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care |
No ID Information.