Provider Demographics
NPI:1952584773
Name:BRAHAM-WILLOUGHBY, MAXINE HILARY (RN)
Entity Type:Individual
Prefix:MS
First Name:MAXINE
Middle Name:HILARY
Last Name:BRAHAM-WILLOUGHBY
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 1:800 FANNING MILL RD
Mailing Address - Street 2:WYNDHAM FARMS
Mailing Address - City:STEWARTSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08886-3224
Mailing Address - Country:US
Mailing Address - Phone:908-859-4844
Mailing Address - Fax:908-859-8255
Practice Address - Street 1:151 KNOLLCROFT RD
Practice Address - Street 2:
Practice Address - City:LYONS
Practice Address - State:NJ
Practice Address - Zip Code:07939-5001
Practice Address - Country:US
Practice Address - Phone:908-647-0180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-14
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR09523600163WG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0600XNursing Service ProvidersRegistered NurseGerontology