Provider Demographics
NPI:1821508946
Name:EASY, MAXINE M (NP)
Entity Type:Individual
Prefix:MISS
First Name:MAXINE
Middle Name:M
Last Name:EASY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:NA
Other - Middle Name:NA
Other - Last Name:NA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:10837 SEAVIEW AVE APT 33C
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-4689
Mailing Address - Country:US
Mailing Address - Phone:347-933-5908
Mailing Address - Fax:
Practice Address - Street 1:10837 SEAVIEW AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-4689
Practice Address - Country:US
Practice Address - Phone:347-933-5908
Practice Address - Fax:718-270-4789
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-03
Last Update Date:2017-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY307815363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner