Individual
MR. JEFFREY JOHN MAYNARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN-NIC, MSN, NNP-BC
Contact information
Practice address
WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER, MEDICAL CENTER BLVD, WINSTON-SALEM, NC 27157-1191
(336) 713-6428
Mailing address
985 MADISON VIEW CT, RURAL HALL, NC 27045-9545
(336) 969-4854
Taxonomy
Speciality
Code
Description
License number
State
363LN0000X
Neonatal Nurse Practitioner
Primary
27023
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7004072
—
NC
Enumeration date
05/14/2007
Last updated
06/25/2014
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