Provider Demographics
NPI:1679038194
Name:FLANIGAN, GLYNIS ANNE (WHCNP)
Entity Type:Individual
Prefix:
First Name:GLYNIS
Middle Name:ANNE
Last Name:FLANIGAN
Suffix:
Gender:F
Credentials:WHCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2927
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-2927
Mailing Address - Country:US
Mailing Address - Phone:503-205-0820
Mailing Address - Fax:
Practice Address - Street 1:3825 WOLVERINE ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97305-1201
Practice Address - Country:US
Practice Address - Phone:888-576-7526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-08
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201901536NP-PP363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health