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General NPI Number Information
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NPI Number | 1053578807
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Entity Type | Individual
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Provider Name | ANGELA C FLYNN PTA
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Gender | Female
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Dates
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Enumeration Date | 05/20/2008
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Last Update Date | 05/13/2016
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Provider Practice Location Address
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Address Line | 200 W CONSTANCE RD
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City | SUFFOLK
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State | VA
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Zip | 23434-4413
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Country | US
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Telephone | 606-669-3232
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Fax |
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Provider Business Mailing Address
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Address Line | 3244 PAGE AVE APT 104
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City | VIRGINIA BEACH
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State | VA
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Zip | 23451-1064
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Country | US
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Telephone | 606-669-3232
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 2306602330
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License Number State | VA
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