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General NPI Number Information
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NPI Number | 1528129376
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Entity Type | Individual
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Provider Name | JEROME MICHAEL MAXFIELD CRNP
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Gender | Male
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Dates
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Enumeration Date | 12/13/2006
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Last Update Date | 12/23/2024
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Provider Practice Location Address
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Address Line | 18947 JOHN J WILLIAMS HWY
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City | REHOBOTH BEACH
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State | DE
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Zip | 19971-4474
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Country | US
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Telephone | 302-645-3770
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Fax | 302-645-5718
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Provider Business Mailing Address
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Address Line | 5501 OLD YORK RD KORMAN-SUITE 202
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City | PHILADELPHIA
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State | PA
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Zip | 19141-3018
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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 |
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | SP008831
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | SP008831
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | R150406
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License Number State | MD
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Taxonomy #4
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | LP-0010842
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License Number State | DE
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