Provider Demographics
NPI:1013943844
Name:STEWART, MAXINE (DC, FNP)
Entity Type:Individual
Prefix:
First Name:MAXINE
Middle Name:
Last Name:STEWART
Suffix:
Gender:F
Credentials:DC, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-2635
Mailing Address - Country:US
Mailing Address - Phone:716-200-4122
Mailing Address - Fax:716-783-8825
Practice Address - Street 1:13430 N SCOTTSDALE RD STE 200
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-4058
Practice Address - Country:US
Practice Address - Phone:888-407-7928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX012374-1111N00000X
NYF341346-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOU66206Medicare UPIN
MO000031527Medicare ID - Type Unspecified