Provider Demographics
NPI:1861191447
Name:MAXWELL, SHARON B (NP)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:B
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12681 S BEAR MEADOW CT
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-9677
Mailing Address - Country:US
Mailing Address - Phone:801-913-1070
Mailing Address - Fax:
Practice Address - Street 1:12681 S BEAR MEADOW CT
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-9677
Practice Address - Country:US
Practice Address - Phone:801-913-1070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-02
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT225316-3102163W00000X
UT225316-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse