Provider Demographics
NPI:1770852568
Name:MAXFIELD, MICHELLE CAROLYNN (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:CAROLYNN
Last Name:MAXFIELD
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 1:24910 LAS BRISAS RD STE 121
Mailing Address - Street 2:MURRIETA FAMILY MEDICINE
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-4035
Mailing Address - Country:US
Mailing Address - Phone:951-698-7550
Mailing Address - Fax:951-698-1521
Practice Address - Street 1:24910 LAS BRISAS RD
Practice Address - Street 2:STE 121
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-4010
Practice Address - Country:US
Practice Address - Phone:951-698-7550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-22
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP18837363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner