Provider Demographics
NPI:1770562696
Name:BELLAMY, MAXINE S (FNP-C)
Entity type:Individual
Prefix:
First Name:MAXINE
Middle Name:S
Last Name:BELLAMY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 PAGE MILL RD STE 103
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306-2073
Mailing Address - Country:US
Mailing Address - Phone:877-731-8994
Mailing Address - Fax:
Practice Address - Street 1:195 PAGE MILL RD STE 103
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-2073
Practice Address - Country:US
Practice Address - Phone:877-731-8994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN085627363LF0000X
CA95018949363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA50BBJXCMedicare UPIN