Provider Demographics
NPI:1760152912
Name:LOUIS, MAXIANA (NP-C)
Entity Type:Individual
Prefix:
First Name:MAXIANA
Middle Name:
Last Name:LOUIS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:884 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-4635
Mailing Address - Country:US
Mailing Address - Phone:347-217-6772
Mailing Address - Fax:
Practice Address - Street 1:1752 FRANCIS LEWIS BLVD
Practice Address - Street 2:
Practice Address - City:WHITESTONE
Practice Address - State:NY
Practice Address - Zip Code:11357-3247
Practice Address - Country:US
Practice Address - Phone:718-746-9494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-19
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY310381363LP2300X
NYF310381-01363LP2300X
NJF310381-01363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care