Individual
REBECA L MAYNARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
2705 N LEBANON ST STE 265, LEBANON, IN 46052-8622
(765) 485-8830
(765) 485-8839
Mailing address
2605 N LEBANON ST, LEBANON, IN 46052-1476
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
02006860A
IN
207RS0012X
Sleep Medicine (Internal Medicine) Physician
Primary
02006860A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300065175
—
IN
Enumeration date
06/01/2018
Last updated
10/11/2023
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