Provider Demographics
NPI:1215381926
Name:FLYNN, HEATHER VIOLET
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:VIOLET
Last Name:FLYNN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:VIOLET
Other - Last Name:PUTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:827 RIVER ST
Mailing Address - Street 2:
Mailing Address - City:ALPENA
Mailing Address - State:MI
Mailing Address - Zip Code:49707-1729
Mailing Address - Country:US
Mailing Address - Phone:989-436-6388
Mailing Address - Fax:
Practice Address - Street 1:827 RIVER ST
Practice Address - Street 2:
Practice Address - City:ALPENA
Practice Address - State:MI
Practice Address - Zip Code:49707-1729
Practice Address - Country:US
Practice Address - Phone:989-436-6388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-19
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other