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NPI Code Detail

MEDICARE: MILLICENT T FLYNN APRN

MEDICARE: MILLICENT T FLYNN APRN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0808XPsychiatric/Mental Health Nurse Practitioner000828CT

General Provider Information

NPI Number : 1669455283
Entity Type Code : Individual
Provider Name (Legal Business Name) : MILLICENT T FLYNN APRN
Provider Business Mailing Address
First Line : 65 KANE ST
Second Line : PROVIDER ENROLLMENT
City : WEST HARTFORD
State : CT
Zip : 06119-2110
Country : US
Telephone Number : 860-523-6421
Fax Number : 860-523-3701
Provider Business Practice Location Address
First Line : 10 TALCOTT NOTCH RD
Second Line : PSYCHIATRY CLINIC
City : FARMINGTON
State : CT
Zip : 06032-1800
Country : US
Telephone Number : 860-679-6700
Fax Number : 860-679-6736
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/29/2005
Last Update Date : 04/02/2015

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