Individual
DEREK MAYNARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
SRNA
Contact information
Practice address
2106 SHADYSIDE RD APT D, SAINT ALBANS, WV 25177-3465
(304) 687-5771
Mailing address
100 ANGUS E PEYTON DR, SOUTH CHARLESTON, WV 25303-1600
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
3017779
KY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/31/2022
Last updated
06/03/2022
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