Provider Demographics
NPI:1881257996
Name:FLYNN, CHARLES ERIC (RN)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:ERIC
Last Name:FLYNN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 369
Mailing Address - Street 2:
Mailing Address - City:CHELAN
Mailing Address - State:WA
Mailing Address - Zip Code:98816-0369
Mailing Address - Country:US
Mailing Address - Phone:509-682-4061
Mailing Address - Fax:509-682-0558
Practice Address - Street 1:215 W. WEBSTER
Practice Address - Street 2:
Practice Address - City:CHELAN
Practice Address - State:WA
Practice Address - Zip Code:98816-0369
Practice Address - Country:US
Practice Address - Phone:509-682-4061
Practice Address - Fax:509-682-0558
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-16
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00171589163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool