Healthcare Provider Details

I. General information

NPI: 1891589966
Provider Name (Legal Business Name): OWEN FRANCIS FLYNN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2025
Last Update Date: 04/05/2025
Certification Date: 04/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 GENESEE ST
ONEIDA NY
13421-2703
US

IV. Provider business mailing address

128 RICHMOND CIR
CHITTENANGO NY
13037-9442
US

V. Phone/Fax

Practice location:
  • Phone: 315-231-5530
  • Fax:
Mailing address:
  • Phone: 315-383-9484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF04240025
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: