MEDICARE: DEBRA HILL MAYNARD MS, RDN

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	133V00000X	Registered Dietitian	L001376	NC

General Provider Information

NPI Number	:	1144620352
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBRA HILL MAYNARD MS, RDN

Provider Business Mailing Address
First Line	:	12213 SHADOW RIDGE LN
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28273-4748
Country	:	US
Telephone Number	:	704-622-9546
Fax Number	:

Provider Business Practice Location Address
First Line	:	12213 SHADOW RIDGE LN
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28273-4748
Country	:	US
Telephone Number	:	704-622-9546
Fax Number	:

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

Provider Enumeration Date	:	08/26/2014
Last Update Date	:	08/26/2014

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