Provider Demographics
NPI:1063471605
Name:MAXWELL, DONNA MARIE (CNM)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:MARIE
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 VETERANS WAY
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32507-1000
Mailing Address - Country:US
Mailing Address - Phone:850-912-2000
Mailing Address - Fax:850-912-2440
Practice Address - Street 1:790 VETERANS WAY
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32507-1000
Practice Address - Country:US
Practice Address - Phone:850-912-2000
Practice Address - Fax:850-912-2440
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2017-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2691192367A00000X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00053316OtherRAILROAD MEDICARE
AL631400143Medicaid
51516112OtherBCBS
51516112OtherBCBS
AL051553720Medicare ID - Type Unspecified