Provider Demographics
NPI:1700386877
Name:FLYNN, ANNE MARIE (NP)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:MARIE
Last Name:FLYNN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:MARIE
Other - Last Name:LIMBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3170 KETTERING BLVD
Mailing Address - Street 2:BLDG B 3RD FLOOR
Mailing Address - City:MORAINE
Mailing Address - State:OH
Mailing Address - Zip Code:45439-1924
Mailing Address - Country:US
Mailing Address - Phone:937-991-3188
Mailing Address - Fax:937-223-9811
Practice Address - Street 1:30 E APPLE ST
Practice Address - Street 2:SUITE 5254 A
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409
Practice Address - Country:US
Practice Address - Phone:937-208-4200
Practice Address - Fax:937-208-4205
Is Sole Proprietor?:No
Enumeration Date:2018-02-15
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.392209163W00000X
OHAPRN.CNP.022348363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0270970Medicaid