Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086X0206X | Surgical Oncologist | 29506 | NE |
NPI | 1417404633 |
---|---|
Provider Name | Ms. Jessica E Maxwell |
First Address | Omaha, NE 68198-8102 |
Second Address | Omaha, NE 68198-3280 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2016 |
Last Update Date | 06/09/2016 |