Healthcare Provider Details

I. General information

NPI: 1306099494
Provider Name (Legal Business Name): CHRISTINE FLYNN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTINE FLYNN

II. Dates (important events)

Enumeration Date: 11/03/2008
Last Update Date: 11/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

398 NEPONSET AVE
DORCHESTER MA
02122-3134
US

IV. Provider business mailing address

50 REDFIELD ST SUITE 302
DORCHESTER MA
02122-3630
US

V. Phone/Fax

Practice location:
  • Phone: 617-282-3200
  • Fax:
Mailing address:
  • Phone: 617-506-5160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number284405
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: