Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 431613 | TX |
NPI | 1043424930 |
---|---|
Provider Name | Elizabeth Ann Flynn |
First Address | Waco, TX 76708-3245 |
Second Address | Waco, TX 76708-3245 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2007 |
Last Update Date | 08/07/2007 |