MEDICARE: DR. STUART MAYNARD PH.D. CRNP, CNS-PMH

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
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	R066358	MD
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	RN1008295	DC
3	364SP0808X	Psychiatric/Mental Health Clinical Nurse Specialist	R066358	MD

General Provider Information

NPI Number	:	1114065869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STUART MAYNARD PH.D. CRNP, CNS-PMH

Provider Business Mailing Address
First Line	:	4500 N PARK AVE
Second Line	:	SUITE 801 NORTH
City	:	CHEVY CHASE
State	:	MD
Zip	:	20815-7239
Country	:	US
Telephone Number	:	301-656-6605
Fax Number	:

Provider Business Practice Location Address
First Line	:	4500 N PARK AVE
Second Line	:	SUITE 801 NORTH
City	:	CHEVY CHASE
State	:	MD
Zip	:	20815-7239
Country	:	US
Telephone Number	:	301-656-6605
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	07/07/2010

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