Provider Demographics
NPI:1457029076
Name:MAYNARD, ERIN MARIE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:MARIE
Last Name:MAYNARD
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 PEBBLE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:DE
Mailing Address - Zip Code:19977-3981
Mailing Address - Country:US
Mailing Address - Phone:443-340-4573
Mailing Address - Fax:
Practice Address - Street 1:314 GROVE NECK RD
Practice Address - Street 2:
Practice Address - City:EARLEVILLE
Practice Address - State:MD
Practice Address - Zip Code:21919-3008
Practice Address - Country:US
Practice Address - Phone:443-282-1197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL1-0044981207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine