Provider Demographics
NPI:1134117336
Name:MAX, DENISE G (CRNP)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:G
Last Name:MAX
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 PHEASANT RUN
Mailing Address - Street 2:SUITE 128
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-3439
Mailing Address - Country:US
Mailing Address - Phone:215-860-3344
Mailing Address - Fax:215-860-8950
Practice Address - Street 1:104 PHEASANT RUN
Practice Address - Street 2:SUITE 128
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940-3439
Practice Address - Country:US
Practice Address - Phone:215-860-3344
Practice Address - Fax:215-860-8950
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ26NJ06925300363LA2200X
PASP004599M363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
S87937Medicare UPIN
PA047393LWHMedicare ID - Type Unspecified
NJ030838DSJMedicare ID - Type Unspecified