Healthcare Provider Details

I. General information

NPI: 1225090061
Provider Name (Legal Business Name): PATRICK W FLYNN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 05/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 N GOVERNMENT WAY
COEUR D ALENE ID
83814-3444
US

IV. Provider business mailing address

205 PARK DR
COEUR D ALENE ID
83814-2148
US

V. Phone/Fax

Practice location:
  • Phone: 208-765-8585
  • Fax: 208-765-8486
Mailing address:
  • Phone: 208-667-4102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRNA87
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: