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General NPI Number Information
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NPI Number | 1386374510
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Entity Type | Individual
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Provider Name | MAXINE A WALLEN-LEWIS CRNP
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Gender | Female
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Dates
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Enumeration Date | 06/11/2022
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Last Update Date | 01/08/2026
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Provider Practice Location Address
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Address Line | 1380 PROGRESS WAY STE 102
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City | ELDERSBURG
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State | MD
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Zip | 21784-6498
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Country | US
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Telephone | 410-795-0257
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Fax |
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Provider Business Mailing Address
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Address Line | 200 MEMORIAL AVE PAYOR CREDENTIALING DEPARTMENT
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City | WESTMINSTER
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State | MD
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Zip | 21157-5726
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Country | US
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Telephone | 410-871-6864
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Fax | 410-871-6516
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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 | R119466
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License Number State | MD
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