Provider Demographics
NPI:1467165647
Name:MAXWELL, CAMILLE KAYDIANE (LPN,MHA)
Entity Type:Individual
Prefix:
First Name:CAMILLE
Middle Name:KAYDIANE
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:LPN,MHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 LYNN DR
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08016-2879
Mailing Address - Country:US
Mailing Address - Phone:609-496-8858
Mailing Address - Fax:
Practice Address - Street 1:563 HIGH ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08016-4592
Practice Address - Country:US
Practice Address - Phone:609-496-8858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-03
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X, 172V00000X
NJ374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No374U00000XNursing Service Related ProvidersHome Health Aide