Provider Demographics
NPI:1407243546
Name:MAKSIN, ALICE RENE (CRNP)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:RENE
Last Name:MAKSIN
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 1:204 MCLAY DR
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:PA
Mailing Address - Zip Code:15037-2338
Mailing Address - Country:US
Mailing Address - Phone:412-303-9940
Mailing Address - Fax:
Practice Address - Street 1:50 OVERLOOK DR
Practice Address - Street 2:
Practice Address - City:LA BELLE
Practice Address - State:PA
Practice Address - Zip Code:15450-1050
Practice Address - Country:US
Practice Address - Phone:724-785-2837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-15
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP014367363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily