Healthcare Provider Details

I. General information

NPI: 1184016826
Provider Name (Legal Business Name): LAURA KENNEDY FLYNN MSN, ANP-BC, NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2015
Last Update Date: 03/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 N VAN DIEN AVE
RIDGEWOOD NJ
07450-2726
US

IV. Provider business mailing address

45 ROYAL AVE UNIT 48
HAWTHORNE NJ
07506-1954
US

V. Phone/Fax

Practice location:
  • Phone: 201-447-8000
  • Fax:
Mailing address:
  • Phone: 973-949-3443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NJ00549700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: