| NPI | 1649381112 |
|---|---|
| Former Name | LESLIE CAROL MAYNARD |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 3003774) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KY 1098680) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2015-08-13 |