Provider Demographics
NPI:1306692801
Name:MAXFIELD, RACHEL ANNE (FNP)
Entity type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:ANNE
Last Name:MAXFIELD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MRS
Other - First Name:RACHEL
Other - Middle Name:ANNE
Other - Last Name:LYMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:4465 S 900 E STE 200
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-2695
Mailing Address - Country:US
Mailing Address - Phone:801-572-3433
Mailing Address - Fax:801-683-6845
Practice Address - Street 1:4465 S 900 E STE 200
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-2695
Practice Address - Country:US
Practice Address - Phone:801-571-3433
Practice Address - Fax:801-683-6845
Is Sole Proprietor?:No
Enumeration Date:2024-04-25
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14041355-4405363L00000X
UT11903251-3102163W00000X, 163WS0121X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No163WS0121XNursing Service ProvidersRegistered NursePlastic Surgery