Provider Demographics
NPI:1376697722
Name:MAXWELL, MARY (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 WASHINGTON ST.
Mailing Address - Street 2:ABOUT WOMEN BY WOMEN
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-5568
Mailing Address - Country:US
Mailing Address - Phone:781-263-0033
Mailing Address - Fax:781-263-0098
Practice Address - Street 1:30 WASHINGTON STREET
Practice Address - Street 2:ABOUT WOMEN BY WOMEN
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-5568
Practice Address - Country:US
Practice Address - Phone:781-263-0033
Practice Address - Fax:781-263-0098
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA152290363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP21274Medicare UPIN
MANP2949Medicare ID - Type Unspecified