Provider Demographics
NPI:1902205909
Name:MAXWELL, BENJAMIN MILES (RN)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:MILES
Last Name:MAXWELL
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-3519
Mailing Address - Country:US
Mailing Address - Phone:970-249-5347
Mailing Address - Fax:
Practice Address - Street 1:601 N 4TH ST
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-3519
Practice Address - Country:US
Practice Address - Phone:970-249-5347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-15
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.0174594163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant