Individual provider Active NPI

Maxine Ceraolo, ARNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Port Angeles, WA
National Provider Identifier
1043808405
Registry record updated Jul 14, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
AP61167344 Issued in WA
Practice address
933 E 1St St
Port Angeles, WA 98362-4012
Phone
(360) 452-7891
Fax
(360) 452-8087
NPI assigned
Dec 31, 2020
Last updated
Jul 14, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 14, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X AP61167344 WA Primary
Psychologist 103T00000X AP61167344 WA
Psychiatric/Mental Health Registered Nurse 163WP0808X 417174 OH

Addresses

Primary practice location

933 E 1St St
Port Angeles, WA 98362-4012

Mailing address

240 W Front St Ste a
Port Angeles, WA 98362-2609
Phone (360) 452-7891

Other identifiers 1

IdentifierTypeStateIssuer
2211667MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220706003549 WA Practitioner - Nurse Practitioner 9638559776 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North Olympic Healthcare NetworkGroup PAC ID 3779895396, 31 clinicians

Practice addresses (Care Compare)

933 E 1St St
Port Angeles, WA 98362-4012
Phone (360) 452-7891

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
417174OHMDPsychiatric/Mental Health Registered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
North Olympic Healthcare Network CurrentSince Aug 1, 2022 Accepting new patients
North Olympic Healthcare Network CurrentSince Aug 1, 2022 Accepting new patients

Locations

1026 E 1st St
Port Angeles, WA 98362
Phone (360) 452-4432

240 W Front St
Port Angeles, WA 98362
Phone (360) 452-7891

240 W Front St
Ste A
Port Angeles, WA 98362
Phone (360) 452-7891

933 E 1st St
Port Angeles, WA 98362
Phone (360) 452-4432

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1609372800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783987200000",
    "number": "1043808405",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "240 W FRONT ST STE A",
            "city": "PORT ANGELES",
            "state": "WA",
            "postal_code": "983622609",
            "telephone_number": "360-452-7891",
            "fax_number": "360-452-8087"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "933 E 1ST ST",
            "city": "PORT ANGELES",
            "state": "WA",
            "postal_code": "983624012",
            "telephone_number": "360-452-7891",
            "fax_number": "360-452-8087"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CERAOLO",
        "first_name": "MAXINE",
        "name_prefix": "Ms.",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-12-31",
        "last_updated": "2026-07-14",
        "certification_date": "2026-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "WA",
            "license": "AP61167344",
            "primary": true
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "WA",
            "license": "AP61167344",
            "primary": false
        },
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "OH",
            "license": "417174",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2211667",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Angeles, WA

Sources for this page

Verify at the official NPI Registry.