Provider Demographics
NPI:1487309266
Name:MAAKESTAD, NAOMI A (FNP-C, CFRN)
Entity type:Individual
Prefix:
First Name:NAOMI
Middle Name:A
Last Name:MAAKESTAD
Suffix:
Gender:F
Credentials:FNP-C, CFRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1991 W CORONA ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85746-6544
Mailing Address - Country:US
Mailing Address - Phone:520-955-2866
Mailing Address - Fax:
Practice Address - Street 1:688 W 4TH ST
Practice Address - Street 2:
Practice Address - City:BENSON
Practice Address - State:AZ
Practice Address - Zip Code:85602-6314
Practice Address - Country:US
Practice Address - Phone:520-720-6551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-19
Last Update Date:2022-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZF02220272363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily