Provider Demographics
NPI:1659781714
Name:MAITLAND, CAROL (RN)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:
Last Name:MAITLAND
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8075 TWIN OAKS DR
Mailing Address - Street 2:
Mailing Address - City:BROADVIEW HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44147-1035
Mailing Address - Country:US
Mailing Address - Phone:440-781-7593
Mailing Address - Fax:
Practice Address - Street 1:2112 CASE PKWY
Practice Address - Street 2:#10
Practice Address - City:TWINSBURG
Practice Address - State:OH
Practice Address - Zip Code:44087-4301
Practice Address - Country:US
Practice Address - Phone:133-042-5847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-29
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.231741163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse