Basic Information
| Provider Information | |||||||||
| NPI: | 1770950651 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MAXIM HEALTHCARE | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1552 S TRENTON CT | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802312636 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037501499 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2460 W 26TH AVE | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802115308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034877143 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/27/2015 | ||||||||
| LastUpdateDate: | 08/27/2015 | ||||||||
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| AuthorizedOfficialLastName: | PETERSON | ||||||||
| AuthorizedOfficialFirstName: | SHARON | ||||||||
| AuthorizedOfficialMiddleName: | LEE | ||||||||
| AuthorizedOfficialTitleorPosition: | ANP | ||||||||
| AuthorizedOfficialTelephone: | 3037501499 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MISS | ||||||||
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| AuthorizedOfficialCredential: | NP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251J00000X | RN0045855 | CO | Y | Agencies | Nursing Care |
No ID Information.