Provider Demographics
NPI:1346599719
Name:FLYNN, NANCY ANN
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:ANN
Last Name:FLYNN
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:NANCY
Other - Middle Name:ANN
Other - Last Name:FLYNN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:15 WOODCREST DR
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-2881
Mailing Address - Country:US
Mailing Address - Phone:716-667-2617
Mailing Address - Fax:
Practice Address - Street 1:2560 WALDEN AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-4757
Practice Address - Country:US
Practice Address - Phone:716-683-5202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-31
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY290001 1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse