Provider Demographics
NPI:1124804885
Name:MAYNARD, RENEE JANET (RN)
Entity type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:JANET
Last Name:MAYNARD
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 1:50 S WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13830-3488
Mailing Address - Country:US
Mailing Address - Phone:607-843-2025
Mailing Address - Fax:
Practice Address - Street 1:50 S WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:NY
Practice Address - Zip Code:13830-3488
Practice Address - Country:US
Practice Address - Phone:607-843-2025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-07
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY756514163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool