Individual
PENNY LOUISE FLAVIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
111 COUNTY ROAD 11 NW, PINE ISLAND, MN 55963-9756
(507) 356-4929
Mailing address
111 COUNTY ROAD 11 NW, PINE ISLAND, MN 55963-9756
(507) 356-4929
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R0980311
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1760434476
NPI
—
01
—
500002158
MEDICARE CLINIC
—
01
—
500002159
MEDICARE HOSPITAL
—
05
—
632240900
—
MN
Enumeration date
05/17/2006
Last updated
09/13/2007
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