Provider Demographics
NPI:1073902540
Name:MAXSON, TONIA (NP)
Entity Type:Individual
Prefix:
First Name:TONIA
Middle Name:
Last Name:MAXSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:TONIA
Other - Middle Name:
Other - Last Name:STANTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2222 S LINDEN RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-5475
Mailing Address - Country:US
Mailing Address - Phone:810-733-0790
Mailing Address - Fax:810-733-0235
Practice Address - Street 1:2222 S LINDEN RD
Practice Address - Street 2:SUITE A
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-5475
Practice Address - Country:US
Practice Address - Phone:810-733-0790
Practice Address - Fax:810-733-0235
Is Sole Proprietor?:No
Enumeration Date:2015-01-21
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704216820363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner