Provider Demographics
NPI:1508332172
Name:NJEI, MAXINE AMECK
Entity Type:Individual
Prefix:
First Name:MAXINE
Middle Name:AMECK
Last Name:NJEI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3328 CHAUNCEY PL APT 102
Mailing Address - Street 2:
Mailing Address - City:MOUNT RAINIER
Mailing Address - State:MD
Mailing Address - Zip Code:20712-1030
Mailing Address - Country:US
Mailing Address - Phone:240-660-7105
Mailing Address - Fax:
Practice Address - Street 1:3328 CHAUNCEY PL APT 102
Practice Address - Street 2:
Practice Address - City:MOUNT RAINIER
Practice Address - State:MD
Practice Address - Zip Code:20712-1030
Practice Address - Country:US
Practice Address - Phone:240-660-7105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-22
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA14062374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide