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General NPI Number Information
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NPI Number | 1306166905
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Entity Type | Individual
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Provider Name | COURTNEY NICOLE FLYNN NP
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Gender | Female
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Dates
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Enumeration Date | 06/04/2010
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Last Update Date | 06/04/2010
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Provider Practice Location Address
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Address Line | 379 E SHORE DR STE 100
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City | EAGLE
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State | ID
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Zip | 83616-5410
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Country | US
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Telephone | 208-938-3443
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Fax | 208-938-3553
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Provider Business Mailing Address
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Address Line | 4082 N BRYCE CANYON AVE
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City | MERIDIAN
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State | ID
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Zip | 83646-4958
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Country | US
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Telephone | 410-458-1712
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | NP-971A
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License Number State | ID
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