Marissa Lynnae Maxham
Pain Medicine
701 Shadwell Ave
Flora
, Illinois 62839-2310
Marissa Lynnae Maxham
Pain Medicine
701 Shadwell Ave
Flora
, Illinois 62839-2310
(618) 842-4138
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About
Features
Specialties
- Pain Medicine
Languages spoken
- English
Location
First Address
- Marissa Lynnae Maxham
- 702 Shadwell Ave
- Flora, IL
- Zip : 62839-2309
- Phone : (618) 842-4138
Second Address
- Marissa Lynnae Maxham
- 701 Shadwell Ave
- Flora, IL
- Zip : 62839-2310
- Phone : (618) 662-8361
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 2081P2900X | Pain Medicine | 160008997 | IL |
National Provider Identifier
| NPI | 1205405859 |
|---|---|
| Provider Name | Marissa Lynnae Maxham |
| First Address | Flora, IL 62839-2309 |
| Second Address | Flora, IL 62839-2310 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 18/06/2021 |
| Last Update Date | 18/06/2021 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.