Individual
MARY E MAXWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1445 PORTLAND AVE, PARNELL OFFICE BLDG, STE 304, ROCHESTER, NY 14621-3036
(585) 342-7170
(585) 342-5855
Mailing address
100 KINGS HWY S, ROCHESTER, NY 14617-5504
(585) 342-7170
(585) 342-5855
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
301455
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02821016
—
NY
Enumeration date
10/04/2006
Last updated
09/04/2020
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