Healthcare Provider Details

I. General information

NPI: 1851505135
Provider Name (Legal Business Name): DONNA MARIE FLYNN RNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 AVOCADO AVE STE 301
NEWPORT BEACH CA
92660-7704
US

IV. Provider business mailing address

PO BOX 9231
NEWPORT BEACH CA
92658-9231
US

V. Phone/Fax

Practice location:
  • Phone: 949-644-2722
  • Fax: 949-760-5438
Mailing address:
  • Phone: 714-746-6530
  • Fax: 714-840-9045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number306257
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: