Provider Demographics
NPI:1831677145
Name:MAXWELL, CAROLINE ELIZABETH (FNP)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:ELIZABETH
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:CAROLINE
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5767 W CENTURY BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-5631
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2020 SANTA MONICA BLVD STE 600
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2131
Practice Address - Country:US
Practice Address - Phone:310-829-5471
Practice Address - Fax:310-829-6192
Is Sole Proprietor?:No
Enumeration Date:2018-07-30
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95013053363L00000X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner