Provider Demographics
NPI:1275308470
Name:MAYNARD, SAVANAH ROSE
Entity Type:Individual
Prefix:
First Name:SAVANAH
Middle Name:ROSE
Last Name:MAYNARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:293 RIGHT FORK LAUREL CRK
Mailing Address - Street 2:
Mailing Address - City:LENORE
Mailing Address - State:WV
Mailing Address - Zip Code:25676-7014
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:293 RIGHT FORK LAUREL CRK
Practice Address - Street 2:
Practice Address - City:LENORE
Practice Address - State:WV
Practice Address - Zip Code:25676-7014
Practice Address - Country:US
Practice Address - Phone:304-733-1094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-17
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant