Healthcare Provider Details

I. General information

NPI: 1235615287
Provider Name (Legal Business Name): MARY FLYNN CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2018
Last Update Date: 07/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7639 KING MEMORIAL RD
MENTOR OH
44060-7028
US

IV. Provider business mailing address

6801 BRECKSVILLE RD
INDEPENDENCE OH
44131-5032
US

V. Phone/Fax

Practice location:
  • Phone: 440-669-9162
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.023145
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: