Healthcare Provider Details

I. General information

NPI: 1821486028
Provider Name (Legal Business Name): SUSAN FLYNN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2014
Last Update Date: 12/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E 5TH ST
SOUTH BOSTON MA
02127-3139
US

IV. Provider business mailing address

601 E 5TH ST
SOUTH BOSTON MA
02127-3139
US

V. Phone/Fax

Practice location:
  • Phone: 617-269-3908
  • Fax:
Mailing address:
  • Phone: 617-269-3908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2281413
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: