Healthcare Provider Details

I. General information

NPI: 1669107025
Provider Name (Legal Business Name): BRENDAN FLYNN CNIM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2022
Last Update Date: 07/20/2022
Certification Date: 07/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9333 MARTIN WAY E STE 214
OLYMPIA WA
98516-5969
US

IV. Provider business mailing address

PO BOX 14546
TUMWATER WA
98511-4546
US

V. Phone/Fax

Practice location:
  • Phone: 360-539-8487
  • Fax: 603-589-9944
Mailing address:
  • Phone: 360-539-8487
  • Fax: 360-358-9944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: