Active NPI
Maxwell Owen Nell
- Pharmacist
- Mauston, WI
National Provider Identifier
1356058374
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 22057-40
- Practice address
- 403 Gateway Ave
Mauston, WI 53948-1402 - Phone
- (608) 847-7814
- NPI assigned
- Oct 31, 2022
- Last updated
- Oct 31, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 22057-40 | WI | Primary |
Addresses
Primary practice location
403 Gateway Ave
Mauston, WI 53948-1402
Mailing address
808 Superior Ave Apt 311
Tomah, WI 54660-4701
Phone (941) 883-1142
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22057-40 | WI | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Current | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Locations
403 Gateway Ave
Mauston, WI 53948
Phone (608) 847-7814
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1667174400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1667174400000",
"number": "1356058374",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "808 SUPERIOR AVE APT 311",
"city": "TOMAH",
"state": "WI",
"postal_code": "546604701",
"telephone_number": "941-883-1142"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "403 GATEWAY AVE",
"city": "MAUSTON",
"state": "WI",
"postal_code": "539481402",
"telephone_number": "608-847-7814"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NELL",
"first_name": "MAXWELL",
"middle_name": "OWEN",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-10-31",
"last_updated": "2022-10-31",
"certification_date": "2022-10-29",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WI",
"license": "22057-40",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mauston, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.