Healthcare Provider Details

I. General information

NPI: 1134684772
Provider Name (Legal Business Name): DONNA O'FLANNIGAN MS, RD, CSP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2019
Last Update Date: 02/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 E THOMAS RD
PHOENIX AZ
85016-7710
US

IV. Provider business mailing address

720 W JUNIPER LN
LITCHFIELD PARK AZ
85340-6013
US

V. Phone/Fax

Practice location:
  • Phone: 602-933-0397
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number859060
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number859060
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: