Healthcare Provider Details

I. General information

NPI: 1104091123
Provider Name (Legal Business Name): GAYLE A MAXWELL APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2008
Last Update Date: 02/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 LAUREL HEIGHTS DR
BRIDGETON NJ
08302-3635
US

IV. Provider business mailing address

215 LAUREL HEIGHTS DR
BRIDGETON NJ
08302-3635
US

V. Phone/Fax

Practice location:
  • Phone: 856-455-6002
  • Fax: 856-455-6106
Mailing address:
  • Phone: 856-455-6002
  • Fax: 856-455-6106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number26NJ00090800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: