Provider Demographics
NPI:1356884894
Name:FLYNN, RACHEL ELISE
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:ELISE
Last Name:FLYNN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 W MCDOWELL RD
Mailing Address - Street 2:4B
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85003-1210
Mailing Address - Country:US
Mailing Address - Phone:602-748-7475
Mailing Address - Fax:602-314-6749
Practice Address - Street 1:115 W MCDOWELL RD
Practice Address - Street 2:4B
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85003-1210
Practice Address - Country:US
Practice Address - Phone:602-748-7475
Practice Address - Fax:602-314-6749
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-01
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLM203176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife