Provider Demographics
NPI:1669067229
Name:MAYWALD, VICKIE LYNN (RN)
Entity type:Individual
Prefix:MRS
First Name:VICKIE
Middle Name:LYNN
Last Name:MAYWALD
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 1:20403 TIMBER RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77355-4969
Mailing Address - Country:US
Mailing Address - Phone:281-356-9592
Mailing Address - Fax:
Practice Address - Street 1:20403 TIMBER RIDGE DR
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77355-4969
Practice Address - Country:US
Practice Address - Phone:281-356-9592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-05
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX595849163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse