Healthcare Provider Details

I. General information

NPI: 1003244815
Provider Name (Legal Business Name): SUSAN FLYNN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2013
Last Update Date: 10/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 PROSPECT ST
NASHUA NH
03060-3921
US

IV. Provider business mailing address

7 PROSPECT ST
NASHUA NH
03060-3921
US

V. Phone/Fax

Practice location:
  • Phone: 603-889-6147
  • Fax: 603-883-1568
Mailing address:
  • Phone: 603-889-6147
  • Fax: 603-883-1568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number068646-21
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: