Provider Demographics
NPI:1326896861
Name:BROWN HUFFSTEAD, MAXINE MAGARETTA (APN -PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:MAXINE
Middle Name:MAGARETTA
Last Name:BROWN HUFFSTEAD
Suffix:
Gender:F
Credentials:APN -PMHNP-BC
Other - Prefix:MRS
Other - First Name:MAXINE
Other - Middle Name:MAGARETTA
Other - Last Name:BROWN HUFFSTEAD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APN PMHNP-BC
Mailing Address - Street 1:1061 VIEWPOINT DR
Mailing Address - Street 2:
Mailing Address - City:LAKE IN THE HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60156-4937
Mailing Address - Country:US
Mailing Address - Phone:847-722-6810
Mailing Address - Fax:
Practice Address - Street 1:1061 VIEWPOINT DR
Practice Address - Street 2:
Practice Address - City:LAKE IN THE HILLS
Practice Address - State:IL
Practice Address - Zip Code:60156-4937
Practice Address - Country:US
Practice Address - Phone:847-722-6810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-09
Last Update Date:2024-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.029573363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health