Provider Demographics
NPI:1770627283
Name:MAXWELL, BRETT
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:
Last Name:MAXWELL
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 1:5801 HORTON ST
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66202-2608
Mailing Address - Country:US
Mailing Address - Phone:913-432-3503
Mailing Address - Fax:
Practice Address - Street 1:5801 HORTON ST
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:KS
Practice Address - Zip Code:66202-2608
Practice Address - Country:US
Practice Address - Phone:913-432-3503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider