Provider Demographics
NPI:1386950483
Name:MAXWELL, JOAN PATRICIA
Entity type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:PATRICIA
Last Name:MAXWELL
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 1:609 E 80TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-3311
Mailing Address - Country:US
Mailing Address - Phone:646-458-1947
Mailing Address - Fax:
Practice Address - Street 1:75 MAIDEN LN
Practice Address - Street 2:7THFLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-4810
Practice Address - Country:US
Practice Address - Phone:646-458-1947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-26
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY320439163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse