Provider Demographics
NPI:1558975391
Name:MAYNARD, RITA LYNN
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:LYNN
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:RT. 152 BOX 36838
Mailing Address - Street 2:
Mailing Address - City:DUNLOW
Mailing Address - State:WV
Mailing Address - Zip Code:25511
Mailing Address - Country:US
Mailing Address - Phone:606-626-9688
Mailing Address - Fax:
Practice Address - Street 1:36838 RT 152
Practice Address - Street 2:
Practice Address - City:DUNLOW
Practice Address - State:WV
Practice Address - Zip Code:25511
Practice Address - Country:US
Practice Address - Phone:606-626-9688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-31
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant