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Individual

DIANNE MAXWELL

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
NP

Contact information

Practice address
1701 W CURTIS ROAD, FAMILY MEDICINE/CONVENIENT CARE, CHAMPAIGN, IL 61822
(217) 365-6203
(217) 326-4003
Mailing address
611 W PARK ST, BWPC, URBANA, IL 61801-2529
(217) 383-6792
(217) 326-4003

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209001591
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0533210001
DMERC
IL
01
500015565
RAILROAD
IL
Enumeration date
11/14/2006
Last updated
03/10/2015
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