Provider Demographics
NPI:1861691651
Name:MAXELL, DIANA JOYCE (FNPC)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:JOYCE
Last Name:MAXELL
Suffix:
Gender:F
Credentials:FNPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6505 LANDMARK DR
Mailing Address - Street 2:# 300
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84098-5999
Mailing Address - Country:US
Mailing Address - Phone:435-615-3914
Mailing Address - Fax:435-615-3926
Practice Address - Street 1:6505 LANDMARK DR
Practice Address - Street 2:# 300
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84098-5999
Practice Address - Country:US
Practice Address - Phone:435-615-3914
Practice Address - Fax:435-615-3926
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT193234-4405363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health