Healthcare Provider Details

I. General information

NPI: 1053573121
Provider Name (Legal Business Name): ASHLEY FLYNN LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2008
Last Update Date: 06/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 WEHRLE DR SUITE 1
WILLIAMSVILLE NY
14221-7037
US

IV. Provider business mailing address

2532 JONES BRIDGE RD
LEICESTER NY
14481-9739
US

V. Phone/Fax

Practice location:
  • Phone: 716-276-2123
  • Fax: 716-276-2129
Mailing address:
  • Phone: 585-704-3770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number277734
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: