MEDICARE: MAXWELL AFORO ADMINISTRATOR

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	163WH0200X	Home Health Registered Nurse	332211	MN
2	374U00000X	Home Health Aide	R069057-5	MN

General Provider Information

NPI Number	:	1891740320
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAXWELL AFORO ADMINISTRATOR

Provider Business Mailing Address
First Line	:	3018 EAST LAKE STREET
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55406
Country	:	US
Telephone Number	:	612-721-7776
Fax Number	:	612-722-3578

Provider Business Practice Location Address
First Line	:	3018 E LAKE ST
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55406-2001
Country	:	US
Telephone Number	:	612-721-7776
Fax Number	:	612-722-3578

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

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	09/11/2025

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