Provider Demographics
NPI:1629731286
Name:CRUZ-AM, MAXINE LUGAY (FNP-C)
Entity Type:Individual
Prefix:
First Name:MAXINE
Middle Name:LUGAY
Last Name:CRUZ-AM
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 DOGWOOD RD
Mailing Address - Street 2:
Mailing Address - City:LINTHICUM HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:21090-2326
Mailing Address - Country:US
Mailing Address - Phone:443-867-7389
Mailing Address - Fax:
Practice Address - Street 1:630 S EXETER ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-4316
Practice Address - Country:US
Practice Address - Phone:410-962-6520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-20
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR223063363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily