Healthcare Provider Details

I. General information

NPI: 1851766372
Provider Name (Legal Business Name): NICHOLE FLYNN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2015
Last Update Date: 08/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 PARKE ST
WEST PITTSTON PA
18643-2205
US

IV. Provider business mailing address

225 PARKE ST
WEST PITTSTON PA
18643-2205
US

V. Phone/Fax

Practice location:
  • Phone: 570-592-8081
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN574279
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP015190
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: