Healthcare Provider Details

I. General information

NPI: 1144785031
Provider Name (Legal Business Name): MAUREEN MACKENZIE FLYNN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2019
Last Update Date: 11/27/2023
Certification Date: 09/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1629 MEDICAL ARTS BLVD STE 200
ANDERSON IN
46011-3454
US

IV. Provider business mailing address

6626 E 75TH ST STE 500
INDIANAPOLIS IN
46250-2890
US

V. Phone/Fax

Practice location:
  • Phone: 765-298-5439
  • Fax:
Mailing address:
  • Phone: 317-621-7547
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License Number71010044A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License NumberR237787
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: