Provider Demographics
NPI:1235757238
Name:MAXWELL, REBECCA MARIE (CNP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:MARIE
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:274 UNION BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-1836
Mailing Address - Country:US
Mailing Address - Phone:303-951-0609
Mailing Address - Fax:
Practice Address - Street 1:274 UNION BLVD STE 110
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-1836
Practice Address - Country:US
Practice Address - Phone:303-951-0609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-07
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0027009363LA2100X
CO0997886363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHAPRN.CNP.0027009OtherAPRN STATE LICENSE