Healthcare Provider Details

I. General information

NPI: 1225192644
Provider Name (Legal Business Name): LAURA FLYNN RD,LD,CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 E TOWN ST 9TH FLOOR
COLUMBUS OH
43215-4600
US

IV. Provider business mailing address

8121 BLIND BROOK CT
COLUMBUS OH
43235-1203
US

V. Phone/Fax

Practice location:
  • Phone: 614-566-8934
  • Fax: 614-566-8004
Mailing address:
  • Phone: 614-430-8379
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number4837
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: