Healthcare Provider Details

I. General information

NPI: 1700341336
Provider Name (Legal Business Name): STEVEN GENE MAXWELL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2019
Last Update Date: 02/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7400 S VIRGINIA ST
RENO NV
89511-1112
US

IV. Provider business mailing address

7400 S VIRGINIA ST
RENO NV
89511-1112
US

V. Phone/Fax

Practice location:
  • Phone: 775-853-5441
  • Fax: 480-247-5562
Mailing address:
  • Phone: 775-853-5441
  • Fax: 480-247-5562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: