Provider Demographics
NPI:1609930916
Name:MAYNARD, SCOTT SPENCER (RN)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:SPENCER
Last Name:MAYNARD
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 OVERLOOK RD
Mailing Address - Street 2:
Mailing Address - City:NARRAGANSETT
Mailing Address - State:RI
Mailing Address - Zip Code:02882-1253
Mailing Address - Country:US
Mailing Address - Phone:401-788-9584
Mailing Address - Fax:
Practice Address - Street 1:24 OVERLOOK RD
Practice Address - Street 2:
Practice Address - City:NARRAGANSETT
Practice Address - State:RI
Practice Address - Zip Code:02882-1253
Practice Address - Country:US
Practice Address - Phone:401-788-9584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRN35475163WH0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0500XNursing Service ProvidersRegistered NurseHemodialysis