Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 3013018 | KY |
NPI | 1740747401 |
---|---|
Provider Name | Mrs. Cindy Nicole Maynard |
First Address | Louisa, KY 41230-9443 |
Second Address | Harold, KY 41635-7064 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2019 |
Last Update Date | 28/02/2019 |