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General NPI Number Information
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NPI Number | 1366704686
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Entity Type | Individual
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Provider Name | ERICA L FLYNN CRNA
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Gender | Female
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Dates
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Enumeration Date | 06/12/2012
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Last Update Date | 12/21/2023
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Provider Practice Location Address
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Address Line | 1225 W LAKE ST
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City | MELROSE PARK
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State | IL
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Zip | 60160-4039
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Country | US
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Telephone | 708-846-5291
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Fax |
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Provider Business Mailing Address
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Address Line | 3998 FAIR RIDGE DR SUITE # 300
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City | FAIRFAX
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State | VA
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Zip | 22033-2921
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Country | US
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Telephone | 703-295-9360
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 041359565
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 209010010
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License Number State | IL
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