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NPI Code Detail

MEDICARE: WILMA LYNETTE MAYNOR FNP-C

MEDICARE: WILMA LYNETTE MAYNOR FNP-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerAP04730LA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1982660627
Entity Type Code : Individual
Provider Name (Legal Business Name) : WILMA LYNETTE MAYNOR FNP-C
Provider Business Mailing Address
First Line : 801 COX RD
Second Line :
City : COTTON VALLEY
State : LA
Zip : 71018-3111
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 401 11TH ST NE
Second Line :
City : SPRINGHILL
State : LA
Zip : 71075-4503
Country : US
Telephone Number : 318-539-1700
Fax Number : 318-539-5688
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/21/2006
Last Update Date : 05/16/2014

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Directions to “ WILMA LYNETTE MAYNOR FNP-C” Practice Location

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