Provider Demographics
NPI:1508120445
Name:FLYNN, CONSTANCE MARY (ANP)
Entity Type:Individual
Prefix:MRS
First Name:CONSTANCE
Middle Name:MARY
Last Name:FLYNN
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 NORTH STREET
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201
Mailing Address - Country:US
Mailing Address - Phone:413-395-7655
Mailing Address - Fax:413-447-2667
Practice Address - Street 1:165 TOR CT
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-3001
Practice Address - Country:US
Practice Address - Phone:413-447-2862
Practice Address - Fax:413-447-2869
Is Sole Proprietor?:No
Enumeration Date:2012-06-26
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA131866363LC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA002905201OtherMEDICARE B