Provider Demographics
NPI:1700361573
Name:MAXWELL, SUE MARIE (LPN)
Entity Type:Individual
Prefix:
First Name:SUE
Middle Name:MARIE
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5506 NW FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68521-3823
Mailing Address - Country:US
Mailing Address - Phone:402-601-9530
Mailing Address - Fax:
Practice Address - Street 1:LINCOLN PUBLIC SCHOOLS
Practice Address - Street 2:5905 O STREET
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510
Practice Address - Country:US
Practice Address - Phone:402-436-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-27
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE21990164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse