MEDICARE: JERRI YOLANDA MAXWELL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	44997	CO

General Provider Information

NPI Number	:	1255513222
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JERRI YOLANDA MAXWELL

Provider Business Mailing Address
First Line	:	4204 ANDES ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80249-7257
Country	:	US
Telephone Number	:	303-373-4331
Fax Number	:

Provider Business Practice Location Address
First Line	:	4204 ANDES ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80249-7257
Country	:	US
Telephone Number	:	303-373-4331
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/03/2007
Last Update Date	:	12/03/2007

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