Provider Demographics
NPI:1659670644
Name:MAYNARD, KAREN LEE (A,P)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:LEE
Last Name:MAYNARD
Suffix:
Gender:F
Credentials:A,P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3015 SW 29TH PL
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33914-3884
Mailing Address - Country:US
Mailing Address - Phone:239-849-9990
Mailing Address - Fax:
Practice Address - Street 1:1361 ROYAL PALM SQUARE BLVD
Practice Address - Street 2:UNIT 4
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-1027
Practice Address - Country:US
Practice Address - Phone:239-939-4299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-16
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2491171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist