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General NPI Number Information
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NPI Number | 1720569858
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Entity Type | Individual
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Provider Name | MARCIA ANN MAXWELL
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Gender | Female
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Dates
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Enumeration Date | 08/27/2018
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Last Update Date | 10/20/2021
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Provider Practice Location Address
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Address Line | 5057 N 19TH ST
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City | MILWAUKEE
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State | WI
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Zip | 53209-5762
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Country | US
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Telephone | 414-716-5971
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Fax | 414-716-5109
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Provider Business Mailing Address
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Address Line | 5057 N 19TH ST
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City | MILWAUKEE
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State | WI
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Zip | 53209-5762
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Country | US
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Telephone | 414-716-5971
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Fax | 414-716-5109
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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 | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 323472-31
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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