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Individual

LISA G. MAYNARD

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
376 W MAIN ST, COVINGTON, VA 24426-1517
(540) 962-4433
(540) 962-4434
Mailing address
376 W MAIN ST, COVINGTON, VA 24426-1517
(540) 962-4433

Taxonomy

Speciality
Code
Description
License number
State
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
0206009194
VA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
009106049
VA
Enumeration date
04/25/2008
Last updated
06/28/2008
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