Provider Demographics
NPI:1275091035
Name:MAYNARD, JENNIFER KUNKEL (LPN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:KUNKEL
Last Name:MAYNARD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3561 BRICKWALL LN
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-6463
Mailing Address - Country:US
Mailing Address - Phone:443-714-1530
Mailing Address - Fax:
Practice Address - Street 1:2200 GARRISON BLVD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21216-2619
Practice Address - Country:US
Practice Address - Phone:240-204-5594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-11
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLP38366164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse