Individual
LEISA L MAXWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
300 DERRY RD, HUDSON, NH 03051-3023
(603) 886-3979
Mailing address
PO BOX 3677, NASHUA, NH 03061-3677
(603) 577-7900
(603) 577-7972
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
15719
NH
207Q00000X
Family Medicine Physician
2003
TN
207Q00000X
Family Medicine Physician
T0649
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1515513
—
TN
05
—
3077200
—
NH
05
—
432680399
—
ME
Enumeration date
08/17/2006
Last updated
03/05/2015
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