Provider Demographics
NPI:1821262437
Name:MAYNARD, CHRISTA SUE (RN)
Entity Type:Individual
Prefix:
First Name:CHRISTA
Middle Name:SUE
Last Name:MAYNARD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:CHRISTA
Other - Middle Name:SUE
Other - Last Name:KLIBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:436 TOWNSHIP ROAD 1055
Mailing Address - Street 2:
Mailing Address - City:PROCTORVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45669-7854
Mailing Address - Country:US
Mailing Address - Phone:740-451-0552
Mailing Address - Fax:
Practice Address - Street 1:1340 HAL GREER BLVD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-3800
Practice Address - Country:US
Practice Address - Phone:304-526-2525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV58366163WC0200X
OH295605163WC0200X
FL9268405163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine