MEDICARE: DESIREE MAYNARD

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	163W00000X	Registered Nurse	103191	HI
2	363LF0000X	Family Nurse Practitioner	APRN.CNP.0040488	OH
3	163W00000X	Registered Nurse	95269665	CA
4	163W00000X	Registered Nurse	463342	OH

General Provider Information

NPI Number	:	1275419665
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DESIREE MAYNARD

Provider Business Mailing Address
First Line	:	PO BOX 932958
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44193-0028
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 W CORRY ST
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45219-1901
Country	:	US
Telephone Number	:	513-872-1530
Fax Number	:

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

Provider Enumeration Date	:	08/12/2025
Last Update Date	:	10/03/2025

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Directions to “ DESIREE MAYNARD ” Practice Location

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