Provider Demographics
NPI:1235430091
Name:FLYNN, MICHAELE (EAMP/ LAC)
Entity Type:Individual
Prefix:MS
First Name:MICHAELE
Middle Name:
Last Name:FLYNN
Suffix:
Gender:F
Credentials:EAMP/ LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 S AINSWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-3348
Mailing Address - Country:US
Mailing Address - Phone:253-380-7764
Mailing Address - Fax:
Practice Address - Street 1:1302 N I ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98403-2118
Practice Address - Country:US
Practice Address - Phone:253-380-7764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-10
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC 2984171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAC 2984OtherSTATE OF WASHINGTON