Basic Information
| Provider Information | |||||||||
| NPI: | 1043558224 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MAXWELL | ||||||||
| FirstName: | WHITNEY | ||||||||
| MiddleName: | SIROIS | ||||||||
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| Credential: | CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5612 SHADY PINE CT | ||||||||
| Address2: | |||||||||
| City: | HOPE MILLS | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283482921 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9104768451 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1341 WALTER REED RD | ||||||||
| Address2: | |||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283044415 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9106153500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2013 | ||||||||
| LastUpdateDate: | 06/19/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 243149 | NC | N | Nursing Service Providers | Registered Nurse | 163WX0002X | 243149 | NC | N | Nursing Service Providers | Registered Nurse | Obstetric, High-Risk | 163WX0003X | 243149 | NC | N | Nursing Service Providers | Registered Nurse | Obstetric, Inpatient | 367A00000X | 678 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
ID Information
| ID | Type | State | Issuer | Description | 243149 | 01 | NC | REGISTERED NURSE LICENSE | OTHER |