Provider Demographics
NPI:1376541037
Name:FLANAGAN, JO EVELYN
Entity Type:Individual
Prefix:MRS
First Name:JO
Middle Name:EVELYN
Last Name:FLANAGAN
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 1:355 E 21ST ST
Mailing Address - Street 2:SUITE J
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92404-4851
Mailing Address - Country:US
Mailing Address - Phone:909-882-0193
Mailing Address - Fax:909-883-4834
Practice Address - Street 1:355 E 21ST ST
Practice Address - Street 2:SUITE J
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-4851
Practice Address - Country:US
Practice Address - Phone:909-882-0193
Practice Address - Fax:909-883-4834
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No174400000XOther Service ProvidersSpecialist