Provider Demographics
NPI:1992284665
Name:MAXWELL, JENNIFER (RN, EMT-P)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:RN, EMT-P
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:PORTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, EMT-P
Mailing Address - Street 1:18805 BETHPAGE DR
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-4851
Mailing Address - Country:US
Mailing Address - Phone:817-897-5991
Mailing Address - Fax:
Practice Address - Street 1:424 SAVANNAH RD
Practice Address - Street 2:
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-1462
Practice Address - Country:US
Practice Address - Phone:302-645-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-13
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX137629146L00000X
TX647990163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic