Provider Demographics
NPI:1861067126
Name:GWINN, MAXALENA HELEN
Entity type:Individual
Prefix:
First Name:MAXALENA
Middle Name:HELEN
Last Name:GWINN
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:PO BOX 412
Mailing Address - Street 2:
Mailing Address - City:QUINWOOD
Mailing Address - State:WV
Mailing Address - Zip Code:25981-0412
Mailing Address - Country:US
Mailing Address - Phone:681-208-0917
Mailing Address - Fax:
Practice Address - Street 1:273 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:QUINWOOD
Practice Address - State:WV
Practice Address - Zip Code:25981
Practice Address - Country:US
Practice Address - Phone:681-208-0917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-20
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant