Provider Demographics
NPI:1528387255
Name:PARRISH, MAXWELL ARTHUR (CRNP)
Entity Type:Individual
Prefix:
First Name:MAXWELL
Middle Name:ARTHUR
Last Name:PARRISH
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4721 KINGSESSING AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19143-3818
Mailing Address - Country:US
Mailing Address - Phone:215-421-5940
Mailing Address - Fax:
Practice Address - Street 1:809 LOCUST ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5507
Practice Address - Country:US
Practice Address - Phone:215-563-0658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-20
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP010754363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily