Provider Demographics
NPI:1568478550
Name:MAXWELL, BARBARA B (APRN)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:B
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 MARLIN DR
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-1116
Mailing Address - Country:US
Mailing Address - Phone:985-645-9066
Mailing Address - Fax:985-730-7183
Practice Address - Street 1:1545 TULANE AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112-2821
Practice Address - Country:US
Practice Address - Phone:504-903-5155
Practice Address - Fax:504-903-5157
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP01767363LS0200X, 363LA2200X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LS0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerSchool
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1196584Medicaid
LA4H770Medicare PIN
LA1196584Medicaid