Individual
MRS. CAROL ALLICIA ANN MAXWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
1035 NIDER BLVD STE 100, VIRGINIA BEACH, VA 23459-8701
(757) 953-8351
Mailing address
620 JOHN PAUL JONES CIR, PORTSMOUTH, VA 23708-2111
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
0024182777
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100348230 (KOHMG)
—
KY
Enumeration date
08/04/2014
Last updated
01/24/2024
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