Healthcare Provider Details

I. General information

NPI: 1528463254
Provider Name (Legal Business Name): LAUREN FLYNN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2014
Last Update Date: 10/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3419 MAIN ST
NEWBERRY SC
29108
US

IV. Provider business mailing address

PO BOX 718
NEWBERRY SC
29108
US

V. Phone/Fax

Practice location:
  • Phone: 803-321-2600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number104853
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: