Provider Demographics
NPI:1730323072
Name:MAXWELL, LILLIE MARIA (LVN)
Entity Type:Individual
Prefix:MISS
First Name:LILLIE
Middle Name:MARIA
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2709 HILLSIDE DR
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76543-4852
Mailing Address - Country:US
Mailing Address - Phone:254-338-8436
Mailing Address - Fax:
Practice Address - Street 1:2709 HILLSIDE DR
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76543-4852
Practice Address - Country:US
Practice Address - Phone:254-338-8436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-30
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX196440164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX175751001Medicaid