Provider Demographics
NPI:1386318731
Name:MAXWELL-BEAL, CONNIE
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:
Last Name:MAXWELL-BEAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3450 NORWOOD PL
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:PA
Mailing Address - Zip Code:18966-2910
Mailing Address - Country:US
Mailing Address - Phone:609-558-8629
Mailing Address - Fax:
Practice Address - Street 1:3450 NORWOOD PL
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:PA
Practice Address - Zip Code:18966-2910
Practice Address - Country:US
Practice Address - Phone:609-558-8629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-08
Last Update Date:2021-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01165900363LG0600X
PASP023700363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology