Individual
MRS. DEADRA MAXWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
500 J. CLYDE MORRIS BLVD, RIVERSIDE REGIONAL MEDICAL CENTER, NEWPORT NEWS, VA 23601-1758
(757) 594-2000
Mailing address
3998 FAIR RIDGE DR, STE 300, FAIRFAX, VA 22033-2921
(703) 766-9737
(703) 766-9725
Taxonomy
Speciality
Code
Description
License number
State
163WC0200X
Critical Care Medicine Registered Nurse
0001129491
VA
367500000X
Certified Registered Nurse Anesthetist
Primary
0024171441
VA
Other
Enumeration date
11/07/2013
Last updated
10/24/2017
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