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General NPI Number Information
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NPI Number | 1841194636
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Entity Type | Individual
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Provider Name | TAISHA L MAYNARD FNP-C
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Gender | Female
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Dates
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Enumeration Date | 10/05/2026
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Last Update Date | 10/05/2026
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Provider Practice Location Address
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Address Line | 1246 STATE ROUTE 38
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City | OWEGO
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State | NY
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Zip | 13827-3217
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Country | US
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Telephone | 607-687-6101
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Fax |
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Provider Business Mailing Address
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Address Line | 116 PARK PL
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City | WAVERLY
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State | NY
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Zip | 14892-1419
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Country | US
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Telephone | 607-725-3432
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 361117
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License Number State | NY
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