Provider Demographics
NPI:1386641355
Name:MAYNARD, SUZANNE (CRNA)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:MAYNARD
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:M
Other - Last Name:SNOWDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:22 BRAMHALL ST
Mailing Address - Street 2:DEPT OF ANESTHESIOLOGY
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102
Mailing Address - Country:US
Mailing Address - Phone:207-662-4562
Mailing Address - Fax:207-662-6236
Practice Address - Street 1:22 BRAMHALL ST
Practice Address - Street 2:DEPT OF ANESTHESIOLOGY
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102
Practice Address - Country:US
Practice Address - Phone:207-662-4562
Practice Address - Fax:207-662-6236
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH033739-23367500000X
NH03373921174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30342549Medicaid