Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0203X | Pediatric Critical Care Doctor | 0101249232 | VA |
N | 2080P0203X | Pediatric Critical Care Doctor | 4301057500 | MI |
NPI | 1174594535 |
---|---|
Provider Name | Norma J Maxvold |
First Address | Richmond, VA 23291-1734 |
Second Address | Richmond, VA 23298-0510 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2006 |
Last Update Date | 24/05/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1558407189 | GROUP NPI (01) | MI |
350D176310 | BCBSM GROUP # (01) | MI |
4532126 | (05) | MI |
E47668 | (02) | MI |