Healthcare Provider Details

I. General information

NPI: 1669868642
Provider Name (Legal Business Name): KATHERINE ELIZABETH MAXWELL CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2015
Last Update Date: 04/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE MLC 3014
CINCINNATI OH
45229-3026
US

IV. Provider business mailing address

3333 BURNET AVE MLC 3014
CINCINNATI OH
45229-3026
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-4788
  • Fax: 513-636-4283
Mailing address:
  • Phone: 513-636-4788
  • Fax: 513-636-4283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberCOA.17138-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: