| NPI | 1396982914 |
|---|---|
| Former Name | CARISSA BETH MAYNARD |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 18311) |
| Additional Taxonomies | 364SA2200X Clinical Nurse Specialist, Adult Health (Licence: NM CNS-00214) |
| 364SA2200X Clinical Nurse Specialist, Adult Health (Licence: TX 734121) | |
| Enumeration Date | 2009-01-20 |
| Last Update Date | 2019-07-26 |