Provider Demographics
NPI:1811468317
Name:MAXWELL, VANESSA F (RN)
Entity type:Individual
Prefix:MISS
First Name:VANESSA
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 1:9423 LORRIE LN
Mailing Address - Street 2:
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-6529
Mailing Address - Country:US
Mailing Address - Phone:901-831-6081
Mailing Address - Fax:
Practice Address - Street 1:9423 LORRIE LN
Practice Address - Street 2:
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654-6529
Practice Address - Country:US
Practice Address - Phone:901-831-6081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-09
Last Update Date:2018-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS867627163WE0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WE0900XNursing Service ProvidersRegistered NurseEnterostomal TherapyGroup - Single Specialty