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General NPI Number Information
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NPI Number | 1063138808
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Entity Type | Organization
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Legal Business Name | MAXWELL NUTRITION
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Dates
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Enumeration Date | 10/13/2022
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Last Update Date | 11/06/2026
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Provider Practice Location Address
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Address Line | 2616 TAYLOR RD STE B
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City | CHESAPEAKE
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State | VA
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Zip | 23321-2247
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Country | US
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Telephone | 757-589-4293
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Fax | 833-740-4130
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Provider Business Mailing Address
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Address Line | 1408 LONGSTREET LN
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City | SUFFOLK
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State | VA
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Zip | 23437-9621
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JEAN MAXWELL
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Credential |
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Telephone | 757-589-4293
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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