Provider Demographics
NPI:1134290133
Name:MAXWELL, CINDY LEIGH (LMP)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:LEIGH
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 KING ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98229-6264
Mailing Address - Country:US
Mailing Address - Phone:360-650-1040
Mailing Address - Fax:360-671-4862
Practice Address - Street 1:1420 KING ST
Practice Address - Street 2:SUITE D
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98229-6264
Practice Address - Country:US
Practice Address - Phone:360-650-1040
Practice Address - Fax:360-671-4862
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00006741174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA230464230464OtherPREMERA
WA91161436800OtherUNIFORM MEDICAL
WA0197824OtherL&I
WA15669OtherREGENCE
WA230464230464OtherLIFEWISE
WA7985013OtherCIGNA