Provider Demographics
NPI:1760922371
Name:MAXIN, ELSIE LAUREL (RNP)
Entity type:Individual
Prefix:MRS
First Name:ELSIE
Middle Name:LAUREL
Last Name:MAXIN
Suffix:
Gender:F
Credentials:RNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4539 N 22ND ST STE N
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-4639
Mailing Address - Country:US
Mailing Address - Phone:239-766-0677
Mailing Address - Fax:
Practice Address - Street 1:4539 N 22ND ST STE N
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-4639
Practice Address - Country:US
Practice Address - Phone:239-766-0677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-01
Last Update Date:2025-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9488439363LF0000X
PASP017235363LF0000X
FLRN9488439163W00000X
PARN691406163W00000X
AZ329691363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse