Provider Demographics
NPI:1417037292
Name:MAXWELL, LADONNA K (APRN)
Entity Type:Individual
Prefix:MRS
First Name:LADONNA
Middle Name:K
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:LADONNA
Other - Middle Name:K
Other - Last Name:LADD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:PO BOX 7167
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59406-7167
Mailing Address - Country:US
Mailing Address - Phone:406-761-5252
Mailing Address - Fax:406-761-3626
Practice Address - Street 1:2300 12TH AVE S STE 101
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-5017
Practice Address - Country:US
Practice Address - Phone:406-761-5252
Practice Address - Fax:406-761-3626
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTRN23096363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT203274480OtherTRICARE & COMMERCIAL
MT000375060OtherBLUE CROSS
MT4306338Medicaid
S12761Medicare UPIN
MT4306338Medicaid