Provider Demographics
NPI:1720387921
Name:MAINES, ROBERT A (RN)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
Last Name:MAINES
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4252 E 100 S APT 3
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46902-9129
Mailing Address - Country:US
Mailing Address - Phone:765-428-8888
Mailing Address - Fax:765-428-8889
Practice Address - Street 1:1013 N 13TH ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904-2011
Practice Address - Country:US
Practice Address - Phone:765-428-8888
Practice Address - Fax:765-428-8889
Is Sole Proprietor?:No
Enumeration Date:2011-03-28
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28168982A163WA2000X, 163WC0200X, 163WE0003X, 163WX1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No163WE0003XNursing Service ProvidersRegistered NurseEmergency
No163WX1100XNursing Service ProvidersRegistered NurseOphthalmic