Basic Information
Provider Information
NPI: 1003244815
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FLYNN
FirstName: SUSAN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 7 PROSPECT ST
Address2:  
City: NASHUA
State: NH
PostalCode: 030603921
CountryCode: US
TelephoneNumber: 6038896147
FaxNumber: 6038831568
Practice Location
Address1: 7 PROSPECT ST
Address2:  
City: NASHUA
State: NH
PostalCode: 030603921
CountryCode: US
TelephoneNumber: 6038896147
FaxNumber: 6038831568
Other Information
ProviderEnumerationDate: 10/15/2013
LastUpdateDate: 10/15/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163W00000X068646-21NHY Nursing Service ProvidersRegistered Nurse 

No ID Information.


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