Individual
JULIANNA MAYNOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
2845 E HIGHWAY 76, SUITE 5, MULLINS, SC 29574-6037
(843) 431-2650
(843) 431-2647
Mailing address
2845 E HIGHWAY 76, SUITE 5, MULLINS, SC 29574-6037
(843) 431-2650
(843) 431-2647
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
3872
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
GP5462
MEDICAID GROUP
SC
05
—
NP0619
—
SC
05
—
RHC 121
—
SC
Enumeration date
10/01/2009
Last updated
06/01/2012
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