Provider Demographics
NPI:1851462014
Name:MAXSON, JANET LEE (APNP, PHD)
Entity Type:Individual
Prefix:MRS
First Name:JANET
Middle Name:LEE
Last Name:MAXSON
Suffix:
Gender:F
Credentials:APNP, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:LEGACY HEALTH CLINIC
Mailing Address - Street 2:1324 20TH AVE SW
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-4040
Mailing Address - Country:US
Mailing Address - Phone:701-838-6000
Mailing Address - Fax:701-838-6024
Practice Address - Street 1:315 MAIN ST S
Practice Address - Street 2:SUITE 205
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-3956
Practice Address - Country:US
Practice Address - Phone:701-857-5854
Practice Address - Fax:701-857-5075
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDPAC0057363A00000X
NDR16251363LF0000X
NDR-16251363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND23509OtherND BLUE SHIELD
ND23509OtherND BLUE SHIELD
NDR16251Medicare UPIN