Provider Demographics
NPI:1528883329
Name:MAYNARD, ELIZABETH M
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:M
Last Name:MAYNARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 MAPLE ST APT B
Mailing Address - Street 2:20
Mailing Address - City:ISLAND POND
Mailing Address - State:VT
Mailing Address - Zip Code:05846-0020
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:235 LAKEMONT RD
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:VT
Practice Address - Zip Code:05855-9507
Practice Address - Country:US
Practice Address - Phone:802-334-6744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-18
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist