Provider Demographics
NPI:1356080683
Name:FLYNN, DEANA HOLLAND
Entity Type:Individual
Prefix:MRS
First Name:DEANA
Middle Name:HOLLAND
Last Name:FLYNN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 WINTERGREEN DR STE B
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-2188
Mailing Address - Country:US
Mailing Address - Phone:910-574-1719
Mailing Address - Fax:910-574-1717
Practice Address - Street 1:220 WINTERGREEN DR STE B
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-2188
Practice Address - Country:US
Practice Address - Phone:910-774-0096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-03
Last Update Date:2023-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5017032363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health