Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 7847 | AZ |
N | 111NR0200X | Radiology | 7847 | AZ |
N | 213ER0200X | Radiology | 7847 | AZ |
NPI | 1033302278 |
---|---|
Provider Name | Dr. Lauren Michelle Maynard |
First Address | Phoenix, AZ 85085-7730 |
Second Address | Phoenix, AZ 85085 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2007 |
Last Update Date | 16/09/2009 |