Provider Demographics
NPI:1457584195
Name:MAXWELL, HEATHER JO (ARNP, CPNP)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:JO
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:ARNP, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 W PAWNEE ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OK
Mailing Address - Zip Code:74020-3020
Mailing Address - Country:US
Mailing Address - Phone:918-358-3588
Mailing Address - Fax:
Practice Address - Street 1:1400 W PAWNEE ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OK
Practice Address - Zip Code:74020-3020
Practice Address - Country:US
Practice Address - Phone:918-358-3588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-28
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK78609363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics