Individual
MRS. BETTY E MAXWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CBRS
Contact information
Practice address
2205 N IRONWOOD PL STE A, COEUR D ALENE, ID 83814-2487
(208) 664-8347
(208) 664-9217
Mailing address
PO BOX 1387, HAYDEN, ID 83835-1387
(208) 415-0299
(208) 625-2070
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P209830J
DRIVERS LICENSE
ID
Enumeration date
10/15/2019
Last updated
10/15/2019
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