MEDICARE: MS. MAXINE ELIZABETH SEABROOK CRNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LW0102X	Women's Health Nurse Practitioner	R080394	MD

General Provider Information

NPI Number	:	1912005000
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MAXINE ELIZABETH SEABROOK CRNP

Provider Business Mailing Address
First Line	:	56 SOUTHGATE AVE
Second Line	:
City	:	ANNAPOLIS
State	:	MD
Zip	:	21401-2830
Country	:	US
Telephone Number	:	410-268-2192
Fax Number	:

Provider Business Practice Location Address
First Line	:	3 HARRY S TRUMAN PKWY
Second Line	:
City	:	ANNAPOLIS
State	:	MD
Zip	:	21401-7031
Country	:	US
Telephone Number	:	410-222-6625
Fax Number	:	410-222-6679

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	07/08/2007

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