Provider Demographics
NPI:1073949186
Name:SWEET, MAXINE WILSON
Entity Type:Individual
Prefix:MRS
First Name:MAXINE
Middle Name:WILSON
Last Name:SWEET
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 BURKE RD
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:FL
Mailing Address - Zip Code:32351-4924
Mailing Address - Country:US
Mailing Address - Phone:850-533-2197
Mailing Address - Fax:
Practice Address - Street 1:226 BURKE RD
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:FL
Practice Address - Zip Code:32351-4924
Practice Address - Country:US
Practice Address - Phone:850-533-2197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-20
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL233280372600000X, 376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
No376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL233280OtherHOMEMAKER AND COMPANIONSHIP SERVICES