Healthcare Provider Details

I. General information

NPI: 1912921131
Provider Name (Legal Business Name): KATHLEEN FLYNN R.N. C.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 10/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 CEDAR ST
SAINT PAUL MN
55101-2209
US

IV. Provider business mailing address

555 CEDAR ST
SAINT PAUL MN
55101-2209
US

V. Phone/Fax

Practice location:
  • Phone: 651-266-1255
  • Fax:
Mailing address:
  • Phone: 651-266-1255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberRN1302037
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: