Provider Demographics
NPI:1225192644
Name:FLYNN, LAURA (RD,LD,CDE)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:
Last Name:FLYNN
Suffix:
Gender:F
Credentials:RD,LD,CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8121 BLIND BROOK CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-1203
Mailing Address - Country:US
Mailing Address - Phone:614-430-8379
Mailing Address - Fax:
Practice Address - Street 1:340 E TOWN ST
Practice Address - Street 2:9TH FLOOR
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-4600
Practice Address - Country:US
Practice Address - Phone:614-566-8934
Practice Address - Fax:614-566-8004
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4837133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH81003Medicare PIN