Healthcare Provider Details

I. General information

NPI: 1619487253
Provider Name (Legal Business Name): SUSAN FLYNN RN-BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13194 S CEDAR RD
CEDAR MI
49621-9581
US

IV. Provider business mailing address

13194 S CEDAR RD
CEDAR MI
49621-9581
US

V. Phone/Fax

Practice location:
  • Phone: 231-835-0693
  • Fax:
Mailing address:
  • Phone: 231-835-0693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704297606
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: