Provider Demographics
NPI:1255619250
Name:MAYNARD, ABIGAIL B (NP)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:B
Last Name:MAYNARD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 SHERIDAN RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04937-3314
Mailing Address - Country:US
Mailing Address - Phone:207-453-3100
Mailing Address - Fax:207-453-3082
Practice Address - Street 1:4 SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:ME
Practice Address - Zip Code:04937-3314
Practice Address - Country:US
Practice Address - Phone:207-453-3100
Practice Address - Fax:207-453-3082
Is Sole Proprietor?:No
Enumeration Date:2011-07-26
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAP111053363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1255619250Medicaid
ME002309001Medicare PIN