Healthcare Provider Details

I. General information

NPI: 1619713930
Provider Name (Legal Business Name): MAXWELL CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2024
Last Update Date: 07/05/2024
Certification Date: 07/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

242 PEARL ST
BURLINGTON VT
05401-8532
US

IV. Provider business mailing address

242 PEARL ST
BURLINGTON VT
05401-8532
US

V. Phone/Fax

Practice location:
  • Phone: 774-266-4793
  • Fax: 833-678-0318
Mailing address:
  • Phone: 774-266-4793
  • Fax: 833-678-0318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KYLE MAXWELL
Title or Position: AUTHORIZED OFFICIAL/OWNER
Credential: PHARMD
Phone: 774-266-4793