Healthcare Provider Details

I. General information

NPI: 1821117755
Provider Name (Legal Business Name): JEAN ANN FLYNN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

299 PEARL ST APT 2D
NEW YORK NY
10038-1847
US

IV. Provider business mailing address

299 PEARL ST APT 2D
NEW YORK NY
10038-1847
US

V. Phone/Fax

Practice location:
  • Phone: 212-791-3154
  • Fax:
Mailing address:
  • Phone: 212-791-3154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number175093-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: