Provider Demographics
NPI:1477768323
Name:MAYNARD, JEFFREY JOHN (RN-NIC, MSN, NNP-BC)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:JOHN
Last Name:MAYNARD
Suffix:
Gender:M
Credentials:RN-NIC, MSN, NNP-BC
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Mailing Address - Street 1:985 MADISON VIEW CT
Mailing Address - Street 2:
Mailing Address - City:RURAL HALL
Mailing Address - State:NC
Mailing Address - Zip Code:27045-9545
Mailing Address - Country:US
Mailing Address - Phone:336-969-4854
Mailing Address - Fax:
Practice Address - Street 1:WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER
Practice Address - Street 2:MEDICAL CENTER BLVD
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-1191
Practice Address - Country:US
Practice Address - Phone:336-713-6428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC27023363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7004072Medicaid