Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | F350105 | NY |
NPI | 1063481042 |
---|---|
Provider Name | Deborah Maxwell |
First Address | North Tonawanda, NY 14120-2019 |
Second Address | Williamsville, NY 14221-3647 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02023090 | (05) | NY |