Healthcare Provider Details

I. General information

NPI: 1679934061
Provider Name (Legal Business Name): NANCY FLAVIN NNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2016
Last Update Date: 03/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 GEORGE BUSH HWY SUITE 250
RICHARDSON TX
75082-3542
US

IV. Provider business mailing address

3001 GEORGE BUSH HWY SUITE 250
RICHARDSON TX
75082-3542
US

V. Phone/Fax

Practice location:
  • Phone: 972-437-5099
  • Fax: 214-343-2814
Mailing address:
  • Phone: 972-437-5099
  • Fax: 214-343-2814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberAP110865
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: