MEDICARE: ABIGAIL BLAKE MAYNARD FNP

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	363LF0000X	Family Nurse Practitioner	115427-23	NH
2	363LF0000X	Family Nurse Practitioner	CNP111053	ME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255619250
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABIGAIL BLAKE MAYNARD FNP

Provider Business Mailing Address
First Line	:	1976 WHITE MOUNTAIN HWY STE 105
Second Line	:
City	:	NORTH CONWAY
State	:	NH
Zip	:	03860-5147
Country	:	US
Telephone Number	:	603-356-4940
Fax Number	:	603-371-3250

Provider Business Practice Location Address
First Line	:	1976 WHITE MOUNTAIN HWY STE 105
Second Line	:
City	:	NORTH CONWAY
State	:	NH
Zip	:	03860-5147
Country	:	US
Telephone Number	:	603-356-4940
Fax Number	:	603-371-3250

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

Provider Enumeration Date	:	07/26/2011
Last Update Date	:	01/06/2026

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