Provider Demographics
NPI:1619487253
Name:FLYNN, SUSAN (RN-BSN)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:FLYNN
Suffix:
Gender:F
Credentials:RN-BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13194 S CEDAR RD
Mailing Address - Street 2:
Mailing Address - City:CEDAR
Mailing Address - State:MI
Mailing Address - Zip Code:49621-9581
Mailing Address - Country:US
Mailing Address - Phone:231-835-0693
Mailing Address - Fax:
Practice Address - Street 1:13194 S CEDAR RD
Practice Address - Street 2:
Practice Address - City:CEDAR
Practice Address - State:MI
Practice Address - Zip Code:49621-9581
Practice Address - Country:US
Practice Address - Phone:231-835-0693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-10
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704297606163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse