Healthcare Provider Details

I. General information

NPI: 1952584773
Provider Name (Legal Business Name): MAXINE HILARY BRAHAM-WILLOUGHBY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2007
Last Update Date: 12/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 KNOLLCROFT RD
LYONS NJ
07939-5001
US

IV. Provider business mailing address

800 FANNING MILL RD WYNDHAM FARMS
STEWARTSVILLE NJ
08886-3224
US

V. Phone/Fax

Practice location:
  • Phone: 908-647-0180
  • Fax:
Mailing address:
  • Phone: 908-859-4844
  • Fax: 908-859-8255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License Number26NR09523600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: