Provider Demographics
NPI:1750810784
Name:MAXWELL, MARJORIE F (RN)
Entity type:Individual
Prefix:MRS
First Name:MARJORIE
Middle Name:F
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2823 N UNIVERSITY DR APT 104
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-1428
Mailing Address - Country:US
Mailing Address - Phone:847-644-0255
Mailing Address - Fax:
Practice Address - Street 1:2823 N UNIVERSITY DR APT 104
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-1428
Practice Address - Country:US
Practice Address - Phone:847-644-0266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-04
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI200060-30207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease