MEDICARE: MISS LILLIE MARIA 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	164X00000X	Licensed Vocational Nurse	196440	TX
2	172V00000X	Community Health Worker		OH
3	164W00000X	Licensed Practical Nurse	196440	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730323072
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS LILLIE MARIA MAXWELL

Provider Business Mailing Address
First Line	:	4963 DONOVAN DR
Second Line	:
City	:	GARFIELD HTS
State	:	OH
Zip	:	44125-2049
Country	:	US
Telephone Number	:	254-338-8436
Fax Number	:

Provider Business Practice Location Address
First Line	:	4963 DONOVAN DR
Second Line	:
City	:	GARFIELD HTS
State	:	OH
Zip	:	44125-2049
Country	:	US
Telephone Number	:	254-338-8436
Fax Number	:

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

Provider Enumeration Date	:	04/30/2009
Last Update Date	:	01/17/2026

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Directions to “ MISS LILLIE MARIA MAXWELL ” Practice Location

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