Provider Demographics
NPI:1922753672
Name:MAXWELL, AMY (NBCHWC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:NBCHWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16192 S. HWY 59
Mailing Address - Street 2:
Mailing Address - City:SILOAM SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72761
Mailing Address - Country:US
Mailing Address - Phone:479-524-7856
Mailing Address - Fax:
Practice Address - Street 1:16192 S. HWY 59
Practice Address - Street 2:
Practice Address - City:SILOAM SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72761
Practice Address - Country:US
Practice Address - Phone:479-524-7856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-21
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA-3505863