Provider Demographics
NPI:1376017624
Name:LAUVER, MAXINE
Entity type:Individual
Prefix:
First Name:MAXINE
Middle Name:
Last Name:LAUVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6601 PHOENIX AVE STE B
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-5092
Mailing Address - Country:US
Mailing Address - Phone:479-785-9091
Mailing Address - Fax:479-782-3415
Practice Address - Street 1:6601 PHOENIX AVE STE B
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-5092
Practice Address - Country:US
Practice Address - Phone:479-785-9091
Practice Address - Fax:479-782-3415
Is Sole Proprietor?:No
Enumeration Date:2019-01-18
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR136322724Medicaid