Healthcare Provider Details

I. General information

NPI: 1154256519
Provider Name (Legal Business Name): KOLLETTE FRANCES MAXWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5450 W DALCROSS DR
BOISE ID
83714-1691
US

IV. Provider business mailing address

5450 W DALCROSS DR
BOISE ID
83714-1691
US

V. Phone/Fax

Practice location:
  • Phone: 775-304-2371
  • Fax: 775-304-2371
Mailing address:
  • Phone: 775-304-2371
  • Fax: 775-304-2371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: