Provider Demographics
NPI:1700375854
Name:NYCE, MAXWELL QUINCY
Entity Type:Individual
Prefix:
First Name:MAXWELL
Middle Name:QUINCY
Last Name:NYCE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2727 W 2ND ST
Mailing Address - Street 2:STE 340
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-4683
Mailing Address - Country:US
Mailing Address - Phone:309-624-4000
Mailing Address - Fax:
Practice Address - Street 1:2727 W 2ND ST STE 340
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-4683
Practice Address - Country:US
Practice Address - Phone:402-463-1250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-03
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL90200000X2084N0400X
NE21752084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty