Provider Demographics
NPI:1215582945
Name:MAYNARD, LAUREN WALL (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:WALL
Last Name:MAYNARD
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:845 SHADES CREST RD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35226-1901
Mailing Address - Country:US
Mailing Address - Phone:205-516-5602
Mailing Address - Fax:
Practice Address - Street 1:2145 HIGHLAND AVE S STE 200
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-4015
Practice Address - Country:US
Practice Address - Phone:205-933-0230
Practice Address - Fax:205-933-6400
Is Sole Proprietor?:No
Enumeration Date:2019-08-08
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-150293363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily