Provider Demographics
NPI:1841806056
Name:MAXWELL, BILLIE JO
Entity Type:Individual
Prefix:MS
First Name:BILLIE
Middle Name:JO
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 1:82 MORNING GLORY DR
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:OH
Mailing Address - Zip Code:45370-9764
Mailing Address - Country:US
Mailing Address - Phone:859-462-3374
Mailing Address - Fax:
Practice Address - Street 1:82 MORNING GLORY DR
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:OH
Practice Address - Zip Code:45370-9764
Practice Address - Country:US
Practice Address - Phone:859-462-3374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-22
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty