Provider Demographics
NPI:1477212447
Name:MAXWELL, KIMBERLY (RN)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 394
Mailing Address - Street 2:
Mailing Address - City:COLBY
Mailing Address - State:WI
Mailing Address - Zip Code:54421-0394
Mailing Address - Country:US
Mailing Address - Phone:715-223-9164
Mailing Address - Fax:608-535-5147
Practice Address - Street 1:200 W SPENCE ST
Practice Address - Street 2:
Practice Address - City:COLBY
Practice Address - State:WI
Practice Address - Zip Code:54421-9800
Practice Address - Country:US
Practice Address - Phone:715-223-9164
Practice Address - Fax:608-535-5147
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-16
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3747P1801X
171M00000X, 373H00000X, 183700000X, 3416A0800X, 146N00000X
SC146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
No183700000XPharmacy Service ProvidersPharmacy Technician
No3416A0800XTransportation ServicesAmbulanceAir Transport
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, ParamedicGroup - Multi-Specialty
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic