Provider Demographics
NPI:1710602214
Name:MAXWELL, ANGELA J
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:J
Last Name:MAXWELL
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:PO BOX 64643
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85728-4643
Mailing Address - Country:US
Mailing Address - Phone:520-909-9691
Mailing Address - Fax:
Practice Address - Street 1:5315 N CALLE LA CIMA
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-4810
Practice Address - Country:US
Practice Address - Phone:520-909-9691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-06
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health