Healthcare Provider Details

I. General information

NPI: 1609275338
Provider Name (Legal Business Name): LESLIE JONES FLYNN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2014
Last Update Date: 06/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6780 MAYFIELD RD
MAYFIELD HEIGHTS OH
44124-2203
US

IV. Provider business mailing address

9500 EUCLID AVE
CLEVELAND OH
44195-0002
US

V. Phone/Fax

Practice location:
  • Phone: 440-312-9010
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN352849
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: