Provider Demographics
NPI:1710404306
Name:OKAFOR, MAXINE C (APRN, PMHNP)
Entity type:Individual
Prefix:
First Name:MAXINE
Middle Name:C
Last Name:OKAFOR
Suffix:
Gender:F
Credentials:APRN, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1902 W UNION HILLS DR UNIT 41331
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85080-4115
Mailing Address - Country:US
Mailing Address - Phone:323-568-1700
Mailing Address - Fax:323-568-1700
Practice Address - Street 1:401 N BRAND BLVD STE 834
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-4451
Practice Address - Country:US
Practice Address - Phone:323-568-1700
Practice Address - Fax:323-568-1700
Is Sole Proprietor?:No
Enumeration Date:2017-08-24
Last Update Date:2025-07-17
Deactivation Date:2025-05-07
Deactivation Code:
Reactivation Date:2025-06-20
Provider Licenses
StateLicense IDTaxonomies
TXAP134780363LF0000X, 363LP0808X
CA95008984363LP0808X
AZ268777363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily