Active NPI
Laqueta R Maze
- Peer Specialist
- Fairborn, OH
National Provider Identifier
1144051525
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Peer Specialist
- License
- APS005305
- Practice address
- 1209 Oakhill Ave
Fairborn, OH 45324-5636 - Phone
- (937) 212-3529
- NPI assigned
- Aug 8, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Peer Specialist | 175T00000X | APS005305 | OH | |
| Peer Specialist | 175T00000X | APS005305 | Primary |
Addresses
Primary practice location
1209 Oakhill Ave
Fairborn, OH 45324-5636
Mailing address
1209 Oakhill Ave
Fairborn, OH 45324-5636
Phone (937) 212-3529
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| APS005305 | OH | MD | Peer Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1723075200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1723075200000",
"number": "1144051525",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1209 OAKHILL AVE",
"city": "FAIRBORN",
"state": "OH",
"postal_code": "453245636",
"telephone_number": "937-212-3529"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1209 OAKHILL AVE",
"city": "FAIRBORN",
"state": "OH",
"postal_code": "453245636",
"telephone_number": "937-212-3529"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAZE",
"first_name": "LAQUETA",
"middle_name": "R",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-08-08",
"last_updated": "2024-08-08",
"certification_date": "2024-08-08",
"status": "A"
},
"taxonomies": [
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": "OH",
"license": "APS005305",
"primary": false
},
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": null,
"license": "APS005305",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fairborn, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.