Provider Demographics
NPI:1700812682
Name:MAINES-LAMARRE, JUDITH (CNM)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:MAINES-LAMARRE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:HAWKINS
Other - Last Name:MAINES-LAMARRE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CNM
Mailing Address - Street 1:PO BOX 600
Mailing Address - Street 2:167 NORTH MAIN STREET
Mailing Address - City:TUBA CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86045-0600
Mailing Address - Country:US
Mailing Address - Phone:928-283-2501
Mailing Address - Fax:928-282-2677
Practice Address - Street 1:167 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:TUBA CITY
Practice Address - State:AZ
Practice Address - Zip Code:86045-0600
Practice Address - Country:US
Practice Address - Phone:928-283-2501
Practice Address - Fax:928-283-2677
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTE30193163W00000X
MER045176163W00000X
MA209022163W00000X
MD10729176B00000X
FLARNP9176982363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered176B00000XOther Service ProvidersMidwife
Not Answered363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ861890Medicaid
8EC304Medicare ID - Type Unspecified
AZ861890Medicaid