Healthcare Provider Details

I. General information

NPI: 1700812682
Provider Name (Legal Business Name): JUDITH MAINES-LAMARRE CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JUDITH HAWKINS MAINES-LAMARRE CNM

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

167 NORTH MAIN STREET
TUBA CITY AZ
86045-0600
US

IV. Provider business mailing address

PO BOX 600 167 NORTH MAIN STREET
TUBA CITY AZ
86045-0600
US

V. Phone/Fax

Practice location:
  • Phone: 928-283-2501
  • Fax: 928-283-2677
Mailing address:
  • Phone: 928-283-2501
  • Fax: 928-282-2677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberE30193
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR045176
License Number StateME
# 3
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number209022
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number10729
License Number StateMD
# 5
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP9176982
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: