Healthcare Provider Details

I. General information

NPI: 1134362809
Provider Name (Legal Business Name): MAREN FLYNN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2009
Last Update Date: 05/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8170 33RD. AVENUE SOUTH MS21110Q
MINNEAPOLIS MN
55440-1309
US

IV. Provider business mailing address

1465 66TH AVE NE
FRIDLEY MN
55432-4766
US

V. Phone/Fax

Practice location:
  • Phone: 952-967-7676
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number56313
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: