Individual
GEORGIA G MAYNARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP
Contact information
Practice address
2835 FORT MISSOULA ROAD, MISSOULA, MT 59804-7408
(406) 721-5600
(406) 721-3907
Mailing address
PO BOX 7609, MISSOULA, MT 59807-7609
(406) 721-5600
(406) 721-3907
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
RN8352
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0432159
—
MT
Enumeration date
07/04/2006
Last updated
07/08/2007
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