Provider Demographics
NPI:1285284356
Name:FOY, MAXINE KIMBERLY
Entity type:Individual
Prefix:MRS
First Name:MAXINE
Middle Name:KIMBERLY
Last Name:FOY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MAXINE
Other - Middle Name:KIMBERLY
Other - Last Name:BENNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5605 AUNKENING STREET
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89081-6488
Mailing Address - Country:US
Mailing Address - Phone:706-495-0139
Mailing Address - Fax:
Practice Address - Street 1:5605 AUNKENING STREET
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89081-6488
Practice Address - Country:US
Practice Address - Phone:706-495-0139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-19
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider