Provider Demographics
NPI:1417217431
Name:FLYNN, MARYELLIN (APRN, NP)
Entity Type:Individual
Prefix:MRS
First Name:MARYELLIN
Middle Name:
Last Name:FLYNN
Suffix:
Gender:F
Credentials:APRN, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIVERSITY OF CONNECTICUT HEALTH CTR
Mailing Address - Street 2:UCONN HOMECARE PROGRAM - OFFICE C1357
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06030-2103
Mailing Address - Country:US
Mailing Address - Phone:860-480-6501
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF CONNECTICUT HEALTH CTR
Practice Address - Street 2:UCONN HOMECARE PROGRAM - OFFICE C1357
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06030-2103
Practice Address - Country:US
Practice Address - Phone:860-480-6501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-23
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTE53483163W00000X
CT4916363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse