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General NPI Number Information
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NPI Number | 1316352651
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Entity Type | Individual
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Provider Name | RYAN GARDNER MAXWELL NP-C
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Gender | Male
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Dates
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Enumeration Date | 06/25/2014
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Last Update Date | 12/12/2025
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Provider Practice Location Address
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Address Line | 8905 SW NIMBUS AVE STE 300
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City | BEAVERTON
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State | OR
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Zip | 97008-7162
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Country | US
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Telephone | 503-352-0468
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Fax |
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Provider Business Mailing Address
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Address Line | 8314 SW 9TH AVE
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City | PORTLAND
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State | OR
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Zip | 97219-4407
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Country | US
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Telephone | 469-338-9262
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP125872
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License Number State | TX
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