Healthcare Provider Details

I. General information

NPI: 1114065869
Provider Name (Legal Business Name): STUART MAYNARD PH.D. CRNP, CNS-PMH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 07/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 N PARK AVE SUITE 801 NORTH
CHEVY CHASE MD
20815-7239
US

IV. Provider business mailing address

4500 N PARK AVE SUITE 801 NORTH
CHEVY CHASE MD
20815-7239
US

V. Phone/Fax

Practice location:
  • Phone: 301-656-6605
  • Fax:
Mailing address:
  • Phone: 301-656-6605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR066358
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN1008295
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberR066358
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: