Provider Demographics
NPI:1700802048
Name:MAXSON, JAN L (CNP)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:L
Last Name:MAXSON
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24701 EUCLID AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-1714
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11100 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1716
Practice Address - Country:US
Practice Address - Phone:216-844-3941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN 173677163WX0200X
OHCOA.07928-NP363LA2100X, 363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No163WX0200XNursing Service ProvidersRegistered NurseOncology
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000509176OtherANTHEM
OH2502492Medicaid
OH363817OtherWELLCARE
OH2833401Medicaid
OH000000221148OtherUNISON
OH7245609OtherAETNA
OH750907OtherBUCKEYE
OHP00908727OtherRAILROAD MEDICARE
OH750907OtherBUCKEYE
Q21553Medicare UPIN
OH2833401Medicaid