Healthcare Provider Details

I. General information

NPI: 1407243546
Provider Name (Legal Business Name): ALICE RENE MAKSIN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2015
Last Update Date: 04/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 OVERLOOK DR
LA BELLE PA
15450-1050
US

IV. Provider business mailing address

204 MCLAY DR
ELIZABETH PA
15037-2338
US

V. Phone/Fax

Practice location:
  • Phone: 724-785-2837
  • Fax:
Mailing address:
  • Phone: 412-303-9940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP014367
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: