Healthcare Provider Details

I. General information

NPI: 1770315939
Provider Name (Legal Business Name): AUTUMN NICOLE FLYNN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2024
Last Update Date: 09/16/2024
Certification Date: 09/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 CLIFFMINE RD STE 110
PITTSBURGH PA
15275-1008
US

IV. Provider business mailing address

481 DRAVO AVE
BEAVER PA
15009-2042
US

V. Phone/Fax

Practice location:
  • Phone: 412-494-4500
  • Fax:
Mailing address:
  • Phone: 619-677-4204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN788136
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP030679
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: