Provider Demographics
NPI:1528488178
Name:O'FLYNN, DIANE
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:O'FLYNN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 RECORD ST
Mailing Address - Street 2:#507
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89512-3370
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:650 RECORD ST
Practice Address - Street 2:#507
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89512-3370
Practice Address - Country:US
Practice Address - Phone:775-322-5497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-22
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker