Provider Demographics
NPI:1124126230
Name:FLANNERY, JUDITH MARY (PNP)
Entity type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:MARY
Last Name:FLANNERY
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:MISS
Other - First Name:JUDITH
Other - Middle Name:MARY
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 PROFESSIONAL CENTER DR
Mailing Address - Street 2:SUITE 311
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94947-4334
Mailing Address - Country:US
Mailing Address - Phone:415-448-1555
Mailing Address - Fax:415-892-8732
Practice Address - Street 1:250 BON AIR RD
Practice Address - Street 2:
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-1702
Practice Address - Country:US
Practice Address - Phone:415-448-1500
Practice Address - Fax:415-461-4229
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171565208000000X
CANPF 3901208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics