Healthcare Provider Details

I. General information

NPI: 1962258871
Provider Name (Legal Business Name): EDEN FLYNN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2024
Last Update Date: 04/30/2024
Certification Date: 04/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 LUBRANO DR STE 105
ANNAPOLIS MD
21401-7559
US

IV. Provider business mailing address

7740 TIMBERCROSS LN
GLEN BURNIE MD
21060-8379
US

V. Phone/Fax

Practice location:
  • Phone: 443-618-3568
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR220149
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: