Provider Demographics
NPI:1669048104
Name:MAYNARD, FRANCES RIETH (FNP-BC PHD)
Entity type:Individual
Prefix:
First Name:FRANCES
Middle Name:RIETH
Last Name:MAYNARD
Suffix:
Gender:F
Credentials:FNP-BC PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 AMES RD
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-2954
Mailing Address - Country:US
Mailing Address - Phone:908-251-1811
Mailing Address - Fax:
Practice Address - Street 1:274 S ORANGE AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-2419
Practice Address - Country:US
Practice Address - Phone:973-732-6040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-03
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01052700363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty