Provider Demographics
NPI:1992203236
Name:MAXON, JOANNA M (RN)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:M
Last Name:MAXON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
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Mailing Address - Street 1:711 TROY SCHENECTADY RD STE 203
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2461
Mailing Address - Country:US
Mailing Address - Phone:518-782-3700
Mailing Address - Fax:518-782-3799
Practice Address - Street 1:47 NEW SCOTLAND AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-3412
Practice Address - Country:US
Practice Address - Phone:518-262-5149
Practice Address - Fax:518-262-4210
Is Sole Proprietor?:No
Enumeration Date:2018-01-31
Last Update Date:2018-02-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY342696363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily