Healthcare Provider Details

I. General information

NPI: 1942502455
Provider Name (Legal Business Name): JEANNE M FLYNN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2010
Last Update Date: 12/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 CROMWELL AVE
ROCKY HILL CT
06067-1801
US

IV. Provider business mailing address

50 SEMINOLE CIR
WEST HARTFORD CT
06117-1429
US

V. Phone/Fax

Practice location:
  • Phone: 866-389-2727
  • Fax:
Mailing address:
  • Phone: 860-233-8562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number004652
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: