Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 2017000048 | MO |
NPI | 1063956910 |
---|---|
Provider Name | Denise Frances Flynn |
First Address | Blue Springs, MO 64015-3069 |
Second Address | Lees Summit, MO 64086-5696 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2016 |
Last Update Date | 24/06/2020 |