Provider Demographics
NPI:1083621635
Name:MAXWELL, ANNE S (APRN)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:S
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:699 FARMHOUSE LN
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-9402
Mailing Address - Country:US
Mailing Address - Phone:406-532-8409
Mailing Address - Fax:406-543-9316
Practice Address - Street 1:232 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:MT
Practice Address - Zip Code:59047-3017
Practice Address - Country:US
Practice Address - Phone:406-222-3332
Practice Address - Fax:406-222-5851
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTRN10648363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTMM1196674OtherDEA REGISTRATION
MTMM1196674OtherDEA REGISTRATION
MTQ40094Medicare UPIN